Soft skills

I’ve become part of the medical culture that minimizes the “soft skills”. Before the brainwashing cult of medical school, I almost worshipped those soft skills. The culture I’m embedded in has made me loathe much of what makes me a good doctor. In general, the men I’ve been working with have little respect for the areas I excel in - palliative, psychiatry, geriatrics, and pain management. They think that patient centred methods are not something any physician should aspire to.

 This has rubbed off on me. Now I think that the areas that I am strong in are not worthy of being considered real medicine. It’s something I’ve been struggling with since clerkship. On all my evaluations, I was lauded for excellent communication and advocacy skills. I never took these seriously because the hidden curriculum taught me that my soft skills aren’t real medicine. I wished that someone would say that my cardiology skills were amazing, or that my physical exam skills are exemplary.

 If these skills are so soft then why do so many physicians have a hard time with them? Maybe there needs to be another name for them. Making a list of possible alternatives, I think about collaboration, organizational, conversational skills, but I imagine these as also being diminished as being too “pink” to be considered real medicine. Could try something like supratentorial skills but given how frequently we use that as code for somatization, that also wouldn’t be treated seriously. Even people skills are “pink” - something we expect those who work in retail to have to learn by watching videos in a break room.

 These “soft skills” are not gained that easily though. Yes, we can learn them through videos and work, but the best of them are learned by experience. By watching what our mentors do well and emulate the people skills they display. We learn them through collaborating with our allied providers and seeing how they advocate for patients. There are no textbooks to show us how to be the best at advocating, listening, collaborating, communicating, organizing, and generally being patient centred. We need to shed tears, sweat, blood, to get to that point.

 These skills are not obvious and difficult to describe, maybe the opposite of concrete skills? Abstract skills? That might work.

 But then again, what is so wrong with calling them soft skills? As long as we start to acknowledge the efforts made to learn them. There shouldn’t be anything wrong with the pink skills that are associated within the soft skills. All physicians should strive to be the best doctors they can. That means practicing their concrete skills, (clinical skills, rote learning, anatomy) as well as their abstract or soft skills. To be a fantastic doctor, one shouldn’t have to hire another MD to provide bedside manner. We should expect it of each other to want to be a complete physician who is able to provide all a patient needs from their specialist or primary care provider.

 If female providers are better at the abstract skills, we should be congratulating them rather than acting like they have done something wrong. I’ve been told several times that I care too much, that I am too passionate. This is ridiculous.

 I want a doctor who is passionate about their job. I want a doctor who cares. No, I don’t want my doc taking their work home with them, spending their night going through all the coulda’ woulda’ shoulda’s. They shouldn’t cross boundaries to make my experience better. But, that doesn’t mean that they shouldn’t cry when they feel like, argue with specialists who refuse to take my care, give 100% during office hours.

 If you think my passion and caring is the problem, I think it’s safe to say that you are the problem. The concrete thinking physicians with a limited view of medicine should really just get the hell out of the way of the physicians who flex both soft and hard skills and are kicking ass. Those are the physicians who are asking the questions in research, are pushing the boundaries of what we are able to do to make our patients’ lives better. We need to repair our culture to catch up with what patients expect from their physicians, and what we expect from our colleagues. The concrete thinking docs need to be called out for being the dinosaurs that they are.

I speak fluent poverty

It doesn't make me terribly popular with administration folks. I've recently been accused of being unprofessional. This stems from the way I talk about and to patients.

I treat my patients as thinking, feeling beings who can make their own choices about their health and their life in general. I call them out on their bullshit and try to find out why they're making the choices they do. There's no point in preaching at a patient about not eating fruits and veg if the food bank has been out for a month.

I don't use flowery language because unfortunately, most of my patients are illiterate. When I started practice, I assumed many would be health illiterate, but I certainly wasn't expecting this. My staff has stepped up (I love them so) and help my patients to fill out the millions of forms that we process every month. I've stopped playing along with "I left my glasses at home" and ask them straight out how their reading is. They've been so used to lying about it, it takes them back and puts them on the defensive for a minute or two until they realize there's no judgement, just me looking to do best by them. I've gotten into the practice of reading out my referral letters to my patients so that 1. I have to finish it while I'm in the room with them, 2. they know what I'm saying about them and 3. they can correct me as I go along. My patients frequently laugh at my "doctor words" that go into those letters. That lets me know that the way I'm speaking with them is different than how I speak with other docs. I like that.

From the stories I hear from my patients, they haven't had someone who will actually listen in a long time. They get painted with the same brush as their drug dealing brother, as their morbidly obese mother, and as their father who has been in and out of jail since they were born. These folks are rarely treated as an important individual.

The same approach works for those patients I have with money and more stable upbringing. I fancy up my language, but otherwise, I continue to treat them as individuals. I don't care that you were mayor for 20 years, we are just starting a relationship, I want to know WHO you are, not what other people see you as.

Part of my approach has to do with my appearance. I've written about this before and I think I've made it clear that I am an untraditional appearing doctor. Most patients ask to see the doctor after I've been in, even when I clearly introduced myself at the beginning. Their response is not one of disbelief but of relief. "oh! you're like a real person!". I'm a bit quirky, I'm overweight, I smile all the time, especially when I don't feel like it. When my patients die, or I need to give someone bad news, or someone has divulged some horrific part of their life, I cry with my patients. It's the only way I can think of to let them know that they matter to me.

I also have a strong feeling for what is and is not fair. This is something that comes through whenever I talk to a child living well below the poverty line. Their anger and emotional outbursts are almost always associated with a feeling that something that has happened is unjust. I grew up well below the poverty line and I still get surges of rage when things are unfair. I've learned to breath deeply, reconsider my stance, and decide whether or not I need to proceed. If I need to proceed, look out. It will feel like molten lava is being rained on your head, because on top of my previous poverty speak, I am now also fluent in affluence, biz speak, economics, and ethics.

This all sounds very Polly-Anna-y, and it might be. Putting my personality in with a hospital that has administration that could, easily, use walkers, doesn't always work. I'm optimistic though that I can persuade admin to my side even through continuing to be patient centred. It's in the mission statement of every hospital of Ontario, including ours. 

That's a silly name

A while ago I had a patient recovering from stroke. She was a sweet, tiny, very old nun.

The stroke had affected her memory significantly. I called her by the name in her chart - Sister Timothy.

Her response: that's a silly name!!

Me: well you chose it!!

Her: call me Susy.

Because that's not a silly name for someone who is almost 100.

- Posted using BlogPress from my iPhone

An American Swimmer Inspires Me

Have you been paying attention to this woman? Holy Moley! Dara Torres is an American swimmer (why I hadn't noticed her before this morning). She's the oldest woman competing in the Olympics. What an inspiration, especially considering how young this field is.


There isn't an age limit on any of the changes we want to make in our lives. Don't say you would do something if you only x years younger. I call your B.S. and tell you to just do it!


I was actually in tears this morning while I was watching the news reports posted above. I was so scared when I first hit my med school class last year, afraid of what they would think of me as so much older than them. Listening to what Phelps said about Torres (mom) made me think that he was being a bit immature. It's so much easier to slough off comments made about Dara than they are about me. What a great lesson. Someone in the class called me Mom once this year b/c I was giving him a hard time when he came to my house (pardon me if I want my kitchen left in one piece). I snapped. I too would prefer to be thought of as an older sister - it makes sense to me since my little brothers are the same age as the class. Either way, I hope I can remember how proud I feel right now of going into med school at my age.

In an unrelated topic, profs/administration/tutors need to back off students. Either they're creeping our Facebook, or complaining that we don't get to class often enough, or bitching about our work ethic. It makes me absolutely crazy. I spent a significant amount of time and energy this week trying to calm down the teachers in the course I'm helping develop - it's ridiculous.