Long ago, I represented a doctor who was….difficult. He was a phenomenal surgeon, world famous in his field, but he was not warm and fuzzy. Not even close. Cold and hard were more his speed. We spent two weeks together, on trial in city hall. It takes about 2 years from the time a case is filed to the time the case goes to court, and during that time all I got was cold and hard. If the research is right, and people sue their doctors for bad communication rather than bad medicine, this doctor was showing me why that might be true. But then we went to trial, and he began to crack. Leonard Cohen has said “there is a crack in everything, that’s where the light gets in”. I remember the moment the light came in with him. It was late at night, we were preparing for trial, and he turned to me and spoke, very softly. “We are walking into your world tomorrow, and it is so different from mine. That’s scary.” He was being vulnerable and admitting something difficult for him to admit–there were some things he didn’t know.
Our relationship changed in that moment. His vulnerability allowed me to see him differently. It helped me to represent him more thoroughly, because I could urge him to embrace that vulnerability, even if just a little. If he could do it with me, he could do it with the jury, and if he could do it with the jury he could do it with his patients. I suspected that if he found a way to let the light come in with his patients, everyone on the healthcare team would benefit.
That’s the last time he was sued, but we’ve stayed close. He called me late one Friday night, eager to share an experience he’d had with a patient that day. She was one of those patients who just never seemed to follow instructions. She’d come to the office on days when she didn’t have an appointment. She wouldn’t get her medications filled, and wouldn’t bring the studies she’d been asked to bring. This doctor was getting frustrated with her, and the ways she was impeding his ability to help her. He’d decided to call her in late on a Friday afternoon to sit down and once again go over his instructions and her questions. The office was practically empty, a big change from the normal hustle and bustle (bordering on controlled chaos) of a busy practice. He reviewed the same instructions he’d reviewed many times before, but this time it was clear she was getting it. “This is wonderful”, she said. “I can hear you.” It turns out she had hearing loss, and the noise of the office had made it hard for her to hear and understand at her visits. There were some things she didn’t understand.
These two stories hold one of the keys to improving healthcare teams. Vulnerability. In my years defending medical malpractice cases, I can’t tell you the number of doctors I’ve seen who are unwilling to say “I don’t know”, and the number of patients I’ve seen who are unwilling to say “I don’t understand.” I believe that if providers and patients can learn to be vulnerable, everyone will be healthier.
Research shows that age-related hearing loss has a negative effect on clinical communication across both hospital and primary care clinical settings. The authors of that study recommend that “content-related and setting-related factors identified as barriers to communication in adults with hearing impairment be incorporated within a patient-centered approach to clinical communication with this patient population.” That may work. You know what else may work? Vulnerability. “I don’t know why you aren’t following our instructions.” “I don’t understand the instructions.” It really could be that simple.
But we won’t know until we try, and vulnerability isn’t easy. If you want to learn more about it, Brene Brown is the expert, and her TED talk is here. It’s worth watching, and then giving vulnerability a shot. Yes, someone has to go first, and it may as well be you. Whether you are a patient, a provider, or a caregiver, try cracking open a little in your healthcare relationships. Let’s see what happens when the light gets in.