Commentary and Perspective
by S. Terry Canale, MD, on "Betting Your Life"
By Alice Stewart Trillin (The New Yorker; January 29, 2001:38-42)

The first thing that I liked about this article by Alice Stewart Trillin is that an orthopaedist (Joe Lane) was the hero! It was his experience and expertise that provided the correct diagnosis. I was also impressed by the fact that both Dr. Lane and the thoracic oncology specialist, Dr. Mark Kris, inspired immediate trust from the patient although their styles of physician-patient communication were quite different. What they had in common was that both saw her as more than "the hot bone scan" or "the suspicious MRI." They saw the whole person and the complete history and proved what we all know but often forget: good communication with the patient can be as important as all the technology that we have available.

Good communication inspires trust, and the trust that a patient has in his or her physician is a vital part of treatment, whether for a life-threatening condition or a relatively minor problem. Patients usually trust their physicians initially because of the physician’s expertise or reputation, but that trust is fostered or negated by a number of factors, such as the physician’s "body language," personality (including his or her humility or, at least, suppressed ego), compassion and empathy, and the ability to communicate and include the patient in shared decision-making.

Over the past two years, the American Academy of Orthopaedic Surgeons (AAOS) has expended considerable resources in helping to make orthopaedists aware of problems in physician-patient communication and in educating them so that they can identify and correct these problems in their own practices. One of our primary messages has been that good communication aids not only the patient but also the physician: it helps to avoid medical errors, lessens the likelihood of malpractice suits, and actually shortens the patient visit. In 2001, the AAOS will sponsor twelve to fourteen orthopaedists for study at the Bayer Institute for Health Care Communication so that they can ultimately help to teach communication skills to other members.

Why is the AAOS placing such an emphasis on communication skills? Because we have recognized that they are as indispensable to good patient care as are our fund of knowledge and experience, tests, and techniques. As in Ms. Trillin’s story, empathy, compassion, and a willingness to listen to the patient often provide the essential clues to diagnosis and are an effective part of the treatment. Explanations and discussions give the patient confidence that the diagnosis is correct and that treatment will be carried out effectively. Reassurance and compassion can soften the impact of an unfavorable diagnosis or an ineffective treatment.

Whatever our personal style of communication, if we let our patients know that we are concerned about them and not just their orthopaedic problem, if we make a real effort to listen as much as we instruct, and if we project compassion as well as competence, we can all be the "hero" in our patients’ stories.