288 Interacting with Their Patients
students to these topics. For example, Jerry, the surgeon-lawyer, saw
other ways to improve communication skills concerning sexuality: teaching
medical students in history-taking not to ask, ‘‘Are you married?’’ but
‘‘Do you have a partner?’’ In speaking about safer sex with patients, Paul
had learned to use blunt, rather than medical, terms to open up con-
versation (‘‘saying ‘fucking,’ ‘sucking,’ and ‘going down’ instead of using
technical words, tends to open things up’’). Professional roles can prompt
professional language that may suboptimally convey information.
Doctors also used their own failures to talk to their providers about
health behaviors, such as unsafe sex, to approach patients more effec-
tively. Jeff, the adolescent specialist with HIV, drew on his experience of
how hard it was to follow his own physician’s advice concerning
nonadherence to safer sex and medications.
I assume health-negating behavior, and take it from there. Doctors
say teenagers lie to them. But teenagers don’t. They can’t tell me
the truth because I’m not being effective in getting to it. So it’s my
problem. When I hear false stuff from a teenager, I’ve screwed up;
they haven’t.
Jeff admitted that he had in fact dissembled to doctors, and hence
learned to ask his patients about health behaviors more effectively than
he had before.
I won’t ask, ‘‘Do you use condoms?’’ but ‘‘Do you use condoms
some of the time, never, or all the time?’’ If they want to say 100
percent of the time, I say, ‘‘Absolutely 100 percent of the time?
Most people slip up once. When did you? How?’’ Again they have
to say, ‘‘No, I’ve never done that.’’ I assume drug experimentation.
The other day, a former patient thanked me: ‘‘I couldn’t tell you
many things, but you would tell me, so then I didn’t have to tell you.’’
Usually, such nonpsychiatrist physicians see these patients first or ex-
clusively, making this ability to gather delicate information crucial.
Giving Bad News: Framing Information
These physicians heightened their sensitivity, too, to how they presented
medical information—the contexts in which they used it, and the need to
ground it in a realistic sense of patients’ experiences. Particularly with poor
prognoses, these doctors highlighted the importance of ‘‘framing data.’’