This week’s post is about some of the challenges of having healthcare conversations when not in a work context. With increasing frequency I get asked to give medical advice and guidance in social settings, often indirectly: i.e. being asked not by the affected individual. When I’m talking about conversations today I’m not talking about the ‘I’ve been prescribed X antibiotic what does it do?’ queries. These kind of queries are about giving information and signposting, rather than diagnosis or critical review. The conversations I’m talking about here are the, ‘my aunt has just been diagnosed with pancreatic cancer, can I send you her biopsy picture?’ type of dialogue. I’m writing this because sometimes, when I back out of these more significant conversations, I worry that it can come across as showing a lack of interest or as being callous and uncaring. The opposite is true, but there are constraints as to how much I can become involved. And some very good reasons why it might be inappropriate… I thought it might be good to share.
First things first. I’m not a medical doctor, I’m a Healthcare Scientist with a PhD and the same post-graduate qualifications as my medical microbiology colleagues. This means that I am qualified to give advice within specific confines linked to infection and infection control. I do not, however, have their broad breadth of experience or – therefore – associated expertise outside of this area. I think it’s really important to be aware of professional boundaries. That said, compared to many members of the public and due to working in infection control (which sits across subject areas), I have an awareness of healthcare linked to a number of disciplines. I thought it was important to write this here because I think if you work in healthcare this delineation is taken for granted. We often forget it’s not as clear to those who don’t.
Are You Talking to Dream or Dr Cloutman-Green?
Many of you who read this blog regularly will know I go by four main names. My friends have called me Dream since I was a teenager, as I was always day-dreaming and walking into things. I get called Elaine by work colleagues and, when I’m in trouble, by my family. My brother and sister have always called me Laney when they are not mad at me. Then there is Dr Cloutman-Green, who you’ll meet in a professional context.
Now I’m no Beyonce/Sasha Fierce, but I do think that there is some context-specific nature to the way I engage with the outside world. I try to be authentically me no matter what context you engage me in, but Dream isn’t the same as Dr Cloutman-Green. Dream drinks shots, enjoys trashy TV and has been known to dance on the odd table. Dr Cloutman-Green deals with making significant and serious decisions all day, everyday, and so has to deal with a fair amount of pressure and stress. As Dream, I do my best to leave that at the door when I come home. It is always quite jarring when Dream gets asked questions and is involved in conversations that are in Dr Cloutman-Green territory.
How Much do You Really Want to Know?
The main issue with Dream having conversations that would normally be had by Dr Cloutman-Green is that Dr Cloutman-Green has access to all kinds of information and resources that Dream doesn’t. Examples of these are when you get called up by a friend or relative asking if they can send you photos/tell you about a friends medical condition. One of the cornerstones of professional practice is understanding when you don’t have all the information and when you are stepping outside the scope of your experience. If I have those encounters in my day job, I have access to medical records, expert colleagues, test results and the ability to recommend follow up investigations. As Dream I have access to none of those things, as well as second hand information given by someone else without knowledge of individual consent.
The other reason that these conversations can be challenging is that you may be aware of the potential serious outcomes of the information you are being given for the individual without the information to determine likelihood. For instance, I am aware of poor outcomes associated with certain cancers. If the person involved has not been prepared for that conversation by their medical professional, or if the conversation has happened and they have not been able to process. Is it appropriate for me to wade in, unaware of the complete story, in what is the professional remit of another healthcare professional?
Finally, if the news is not good there is a reason that these conversations are undertaken by a healthcare professional with some distance from the situation, rather than your friend/relative. Emotions can be targeted, whether justified or not, at the person delivering the news. There is a reason we talk about ‘don’t shoot the messenger’ and ‘being the bearer of bad tidings’. Being involved in these conversations, whilst not being so involved as to have all the information, can result in permanently changed relationships on both sides. It strikes me that in these circumstances I should mostly be there to signpost and support as a friend, not acting as their medical professional.
Having laid out my rationale you would have thought it would be fairly simple to keep these worlds siloed, but it isn’t. These conversations are often sudden or sprung in unusual situations where you’re not expecting them and, therefore, take time to adapt and respond to. Hence the fear of coming across as distant.
But I Thought I Was Just Here to Party?
Stepping away from the more serious conversations, there is just one more setting where I find this topic difficult:
The Art Of Parties.
Now I work in a paediatric setting and so, understandably, many people want to talk to me about paediatric infections. That sits well within my ball park of expertise. There have been occasions, however, that despite this, and the situation not requiring serious conversations, I’ve not wanted to engage. I was once invited to a party (it was supposed to be child free) and when I arrived, apart from my husband and I, everyone there was a family unit with kids in tow. That’s fine – I’m OK with that. As the afternoon/evening progressed, however, I became progressively less happy. I was basically on a conversation carousel of parents who wanted to talk about herbal remedies for their kids cold, whether the fact that their child had had three colds that year warranted paediatric referral, or whether vaccination X should wait because of their trip to Y. After 6 hours I had managed not a single Dream conversation. Nothing on a non-healthcare subject. Not one conversation about movies, books, geekery or the things I enjoy talking about outside of work. Not only that, but because I kept being pulled into these conversations, I felt less and less like I was at a party and more and more like I was work.
When all is said and done, I expect to talk and love talking about science, medicine and my day job. After all, I have the best job in the world. There are just also times when I need to talk about things that aren’t linked to these. I struggle with small talk and therefore really don’t help myself as sometimes (well quite often) my work is all-encompassing. It is therefore frequently my own fault and actually just a way that people use to try and connect with me. It’s something I need to work on. If we do meet in a social setting though, please talk to me about tea, cake, your favourite novel/film/TV show and help me be Dream/Elaine rather than Dr Cloutman-Green. I’m keen to know more about you.
Also, if we meet and you do want a serious health-based conversation, understand that, if I don’t fully engage, it’s not because I don’t care about you. It’s because I care about you enough that I want you to have medical advice from the person who has access to all the information and resources to take the best care of you, your healthcare professional. Also know its because I value you and our relationship enough that I don’t want to risk it being damaged by changing the context of that relationship to something that should be more distant and professionally limited. I’m still here for you, and I still want to support and signpost, but let me be your friend rather than your Dr.
All opinions on this blog are my own