Dr. Gretchen Berland, an assistant professor at the Yale University School of Medicine and former documentary filmmaker, writes in the New England Journal of Medicine of an extraordinary experiment she has conducted over the past 10 years. It involved giving videocameras to people in wheelchairs, and asking them to document their daily lives (samples of the videos can be seen here). The footage provides insight into the struggles faced by the disabled in conducting daily activities; it also provides a penetrating view of what happens during visits to the doctor, replete with considerable potential for communication breakdowns. At best, a common result is that doctors don’t get the full story of a patient’s condition; at worst, the patient can wind up receiving inadequate or improper care. Berland describes her findings as follows:
By the time Galen Buckwalter‘s physician knocked on the exam-room door, Buckwalter’s video camera had been recording for nearly 40 minutes. He had booked the appointment because his shoulders were hurting, and the camera recorded his view of the examination table, the comments he made while waiting and, eventually, a largely transactional and superficial exchange with his physician. Two weeks later, in his home, the camera would record a strikingly different take on his shoulder pain – a growing problem that, Buckwalter worried aloud, might cost him even more of his cherished independence.
As an internist, I was disturbed by the contrast between those two scenes, the second revealing the depth of Buckwalter’s concerns and fears, none of which were apparent during the conversation with his doctor. In the later tape, Buckwalter’s struggle is palpable. If such stark contrasts are common, how much do I really know about my own patients? Probably far less than I care to admit.
Berland candidly assesses a major flaw in our healthcare system, the various shortcomings of which Dubner has discussed before. Incomplete communication during visits only adds to the existing soup of unnecessary treatments, huge expenses, and potentially deficient coverage. Surely there must be ways, besides a basic “Yes/No” survey on a clipboard, to streamline the process of initial doctor visits so that patients feel comfortable giving physicians the bigger picture. Perhaps an online log that patients can fill out and doctors can review before the appointment, describing conditions and symptoms in detail, or even documenting pain levels for the few days prior to the visit? Any other ideas?