There are few places where good communication is more necessary than when a patient and doctor are having a serious discussion.

There are few places where bad communication happens more often than in that same scenario.

In over 15 years of ministry, there has only been one time where I interjected myself into a medical situation. As a pastor, my job is to support everyone involved, not to be an actor in the drama. But one time I made an exception. A church member was in the hospital. He was older, in ICU, and it looked like the end was near. The doctors weren’t certain what was wrong with him. He was aware, he couldn’t speak. (See: You Don’t Know That I’ll Be Fine)

As I spoke in the waiting room to his wife, she mentioned having signed a DNR for her husband. It caught me off guard.  Why would she sign a DNR when he was fully cognizant? Who would allow her to do so and why wasn’t his opinion sought? She said she felt pressured to do so by a nurse.

Normally, I try to fully support patients, medical staff, and family in hospital situations. My opinions don’t matter and even if asked, I’m hesitant to state them. But this felt different. I needed to do something.

I called a friend who was a hospital administrator and said, “I’m going to tell you a situation and you can do with it whatever you wish but I have to at least tell someone.” I told him the story. Within the hour the DNR had been rescinded and the patient was consulted on what he wanted to do with his medical treatment. In a brief period of time, a simple explanation was given for his inability to communicate and he was released from the hospital within a week.

Life and death are often on the line when we are speaking with medical professionals. Yet because they deal with these issues every day and we deal with them only in rare situations, miscommunication is guaranteed to occur. Add to this dynamic fear, uncertainty, and mistrust and miscommunication becomes the norm rather than the exception.

It’s difficult to do, but patients, family members, and anyone who might be a power-of-attorney must use great care when speaking with medical providers in order to ensure the proper care for themselves or loved ones.

Tensions Which Lead to Miscommunication

1. Patients often hear what they want to hear and doctors often say what the patient wants to hear. It’s not that doctors lie, but human nature makes it more difficult to deliver bad news. We naturally tend to soften bad news. So doctors are tempted to be more positive than a situation might require and patients will often search for anything hopeful in what the doctor has to say. This can lead to patients assuming things are better than they are.

2. Patients and doctors often have differing definitions of success. The ultimate goal for most doctors is to keep the patient alive for as long as possible. Unless they are told differently, that is their aim. The ultimate goal for most patients is more focused on quality of life. Because success is defined differently by the two parties, both assume good communication is happening when it actually isn’t. When a doctor says, “If this treatment is successful…” he might mean the patient will be alive next week while the patient and family might assume the patient will be home and happy. (See: Never Confuse Acceptance for an Absence of Faith)

3. Patients and doctors have differing levels of knowledge, but don’t acknowledge it. Many patients are afraid to ask questions because they don’t want to look dumb. Many doctors are afraid to over-explain a scenario because they don’t want to talk down to the patient. So the doctor talks, the patient/family nods their head, and they think communication is happening. It’s not.

4. High emotions and pressed time makes good communication difficult. Few conversations in life can be as important as that between doctor and patient, yet most people do not prepare for the conversation. They do not write down questions. They do not have a third party present who is more objective or knowledgeable about the subject. They often just wing it. While the patient is overwhelmed with emotions (sometimes about life and death), the doctor is extremely pressed for time. The demands of their schedule do not allow them to take the time necessary for good communication. And now, doctors often are having to input data while talking which doesn’t allow them to read body language or hear everything that is said.

How to Communicate When Your Life’s on the Line

While good communication can’t be guaranteed there are some basic steps every person can take to aid the process.

1. Take control of your personal healthcare. While you should trust your doctors and recognize their knowledge, you should never fully entrust your care to another. You are in charge and the doctor is your main adviser. You don’t have to understand everything, but you should have a good comprehension of what is happening and what is the best response to the diagnosis.

2. Prepare for important conversations. Write down questions. Clarify points of confusion. Find an advocate who can objectively listen to the conversation between you and a doctor to spot any confusion. Prepare a living will and have a framework determined of what you and your family member may want in the worst case scenarios–under what conditions would your forgo treatment, when should you be resuscitated or not be resuscitated, etc.

3. Always define outcomes. What does success mean to you? What does it mean to the doctor? What is the best case scenario for the recommended treatment? What are you willing to endure and what do you want to avoid at all costs? What do you value the most–more time or more comfort or certain activities, etc? (See: Don’t Believe the Lie–“If You Have Your Health…”)

4. Realize medicine is not black and white. When doctors talk, they are often speaking in terms of percentages. They don’t mean for their words to be taken as written in stone. They are doing the best that they can to communicate what they know. Acknowledge their humanity while deeply respecting their study and knowledge.

Chances are, at some point in your life you will sit across from a doctor and she will tell you that either you or your loved one’s life is on the line. It’s a moment you can never fully be prepared to face, yet it will be one of the most important conversations of your life. There is no reason why that conversation can’t be overwhelmingly productive. While it is never easy, if everyone involved does their best, good decisions can result from the talk.