on explanations

I've recently discovered that it can be quite difficult to explain things to patients.  Or maybe it's just difficult to find the right words quickly to make complex problems easier to understand.  Or perhaps it's that they ask a lot of random questions that never occurred to me before the conversation started and I am no longer good at thinking on my feet while talking and remaining calm.  I didn't think that I would find that intimidating, but I do!

Let me explain it this way.  It's kind of similar to when you just know that your preceptor is about to pimp you on something, and it turns out that it is actually about something that you reviewed recently. Hooray! The start of a thought boldly blurts itself out your mouth with confidence, but about five words in you realize you might not have gathered enough thoughts yet and so you stall out a little and try to gun it to the end, but the end turns out to be a mangled jumble of incoherent thoughts.  At which point I usually semifrownsmile and awkwardly look from side to side as though maybe my brain was accidentally placed on the desk next to me the whole time.  This is the kind of behavior, as you can imagine, that instantly gives your patients a strong sense of confidence in you. 

I think that I may possibly be getting a teeny bit better at this particular challenge.  But really, the bar was pretty low because before my minimal improvements I just fervently prayed that no questions would be asked and my words would just be wholeheartedly accepted as the gospel truth and we could all just go along on our merry ways.  Which was ridiculous, especially since I mostly couched all of my patient discussion in heavy self-doubt and pre-apologies for being just a lowly, meek, baby PA student. and then excusing myself to go find a real person.

In small slices, here are a few of the interactions that have occurred recently that didn't completely fall apart in my novice hands:

I sat with a patient's wife in the waiting room and patiently re-explained the heart catheterization procedure that we had just done on her husband and reviewed what we had found and what the next steps would be even though I was scared that I might say the wrong thing.

I talked with a motorcycle man about risk factor modification for the prevention of future cardiac events, and I told him I always wear my helmet whilst scooting and that I fully expected him to as well.

I explained the different ideas we had on the etiology of a heart attack my patient had had the night before, and what we had found when were paged to come in to the lab late at night to open up her coronary arteries, even though I had to explain that we weren't exactly sure what had occurred.

I listened to a patient struggle to describe his understanding of what had just happened to him, and I worked to help him find a better hold of that information, even when it took me a long time to find the right combination of words.

I held my patients hand and reassured her while the anesthesiologist administered IV sedatives when she told me she was afraid she wouldn't wake up, even though I couldn't one hundred percent tell her that she would. 

I'm not sure those tiny interactions describe it, but very slowly I think I am moving in the right direction.  Some days it feels like all I can do is stand still to not move backwards, and I try to accept that as progress.  But on other days, I know I'll be fine.