Giving Advice

Here is what I do well: I am a good listener. People feel reasonably comfortable sharing secrets. Most of my closest friends know that I will listen and be understanding to what is going on in their lives. I am comfortable asking lots of questions to get to the bottom of how a person is thinking or feeling. And usually it is done in a completely non-judgemental tone (I am usually without judgement-- although there was this one time where I was "practicing" interviewing a patient---he was a homeless man who smoked tons of crack cocaine. For some reason I was completely fine with that. It wasn't until he told me that he had 9 kids til I freaked with out with a high pitched "Nine kids?!?!" response. The med student I was working with completely lost it) I think I've been able to apply this to medicine---I can get a good story from the patient--the who, what , where and why and also how they were feeling, and what they think the reason this occurs.

Here's where I need help: So once I find out that my 15 year old patient has been having unprotected sex and drinking every weekend, I fail at telling them why it's a bad idea to be doing what they are doing. I am good at getting the info, I just stink at giving them the medical advice. (I think I may stink at giving friends advice as well). So then I go report to the attending that they are doing this risky behavior and they always ask "So what did you tell the patient?" Thats when I stutter and say something about how I wanted to see how the attending handles it because I've never crossed this bridge before. When in fact, I've had at least a dozen patients like this and I just stink at at it. I think I am worried about coming off as being judgemental. I can remember my dentist making me feel bad when I wouldn't floss---I never wanted to see him again!!! I am worried that I will lose the patient forever and then when they do get an STD, or start coughing up blood after 50 years of smoking---they won't come into the doctor and ask for help; instead they will pass the disease on or die of cancer.

On my current rotation---family medicine---I've started trying to speak up. This is part of a doc's job---recommend some actions (take this medicine) and to dissway patients from others (pretty much everything else) Here's to me finding a voice!!