Most modern methods of communication suffer from serious deficiencies.  They are one-way messages, or they require much more work than the telephone to have two-way communication.  Matters such as quality, veracity and authority of the message are degraded in systems like texting.  Marshall McLuhan was a man before his time on this topic.

For instance, patients leave messages such as “call me.”  At least, when patients telephone to request a return call, the receptionist can obtain some understanding of what the concern of the patient is.  I hate to telephone and be asked – “Are my labs back yet?”  Answer – “no.”  A wasted phone call – there’s nothing useful I can offer that a medical assistant couldn’t have answered.

In one-way communication, there is a tendency to “throw responsibility over the fence.”  I hear people say, “Well, I keep emailing the doctor – but no response!”  as though it’s the recipient’s obligation to snatch up fresh e-mails as soon as you press send.  I’ve had a nonmedical colleague at an institution e-mail me with “terrible heavy chest pain,” and I caught the email three hours later.  E-mail is a lousy way to communicate regarding chest pain.  Should a text & email system be set up that takes priority over the patient in the room – and should that pre-emption be at the prerogative of whomever wishes to text or email?

On quality – “Do my liver enzymes look good?”  A three-second question with a five-minute answer that requires looking through the chart, assessing whether the patient has any problems related to liver disease, and interpreting the body of the chart in balance with new information.  Cirrhotics can produce a bunch of swell numbers for liver enzymes, while at end-stage.  Patients are used to vapid news such as “The Dow is up 50 points.”  Of course, that means nothing, but they want to hear the equivalent vapid results from physicians – “Your ALT is down 5 points.”  What does that mean?  Bupkis.

On veracity – “What’s my EKG look like?”  It’s mostly flat red lines, with an occasional series of blips.  Some people think that “machine reads” of EKG’s are the be-all and end-all of the process.  Somebody can read the machine-reads to them.  But our job is to understand – what’s going on with the patient?  A twitter question is unanswerable.

On authority – a patient might say that his sister-in-law looked at the EKG and is concerned.  On the other hand, if you, as a provider, express concern, you are speaking from a position of authority.  As much as modern medicine attempts to erase the authority and responsibility of the provider, and fling the risk back on the patient, we are asked to make a call bearing great responsibility.  Oopsy is not a decent followup statement from us the doctors.  Our President-Elect runs into conflict on this matter.  When I say, let’s double the nuclear arsenal, so what?  But when Donald Trump says it, people cringe.  It IS being heard as though it is authoritative policy, whether or not he intends to offer it as policy or just a wisp of whim.

I can’t believe how badly communication has been wrecked by the plethora of media by which to communicate, and their unreliability.  When there was only telephones, only telephones were necessary.  Now, you can be tweeted by one patient, and be emailing the next, while the fellow or lady is shivering on the exam table.  I’m sure that most people consider texting during pap & pelvic to be a faux pas.  Where are we going with all this?


p class=”MsoNormal” style=”text-indent:.2in;line-height:135%;margin:12pt 0 6pt;”>Now, Thoreau was concerned that – “We are in great haste to construct a magnetic telegraph from Maine to Texas; but Maine and Texas, it may be, have nothing important to communicate.”  And a Congressional committee may have erred when it concluded, “As to Bell’s talking telegraph, it only creates interest in scientific circles, and, as a toy it is beautiful; but … its commercial value will be limited.”  I think the talking telegraph has proved its worth at the doctor’s clinic.  But after that, I think the jury’s out.