Communication

“What we've got here is a failure to communicate.”

—Paul Newman in Cool Hand Luke

I was in Subway the other day for lunch and ordered my customary 6” spicy Italian sub. I've done this more than once before and there was long line behind me. After ordering I tried to obviate the usual questions from the young Indian woman making my sandwich by saying, “Italian bread, everything except mayo and oil.”

She replied, “Tharschted?”

I blinked a few times and stared back blankly.

She repeated, “Tharschted?”

I nervously scanned the condiments figuring there must be some new spice called “tharscht.” No luck. I was stumped. I thought to myself, that this is exactly why I never go to Starbucks and when forced, I always order black coffee. Everything there is codified and I am not cool enough to know what any of it means much less how to order it. Now I can't even get a sandwich.

Still clueless, I replied, “Pardon me?”

“THAR-SCH-TED?” she again repeated the mantra. This time, she spoke slowly and louder, enunciating every pseudo-syllable. As you know, this is the universal sign for “I am talking to an idiot.”

The growing line of hungry people behind was now becoming palpably impatient, wondering why the moron ahead of them was having a conversation about his sandwich. And I was clueless. At this point, as long as she didn't spit on the sandwich, I'd have happily taken anything.

Finally, I somewhat sheepishly admitted, “I'm sorry but I have no idea what ‘tharscht’ is.”

Her eyes widened and she looked at me as though I'd lost my mind. She motioned to the toaster oven with my unfinished sandwich and quizzically repeated, “Tharschted?”

“Oh, toasted,” I chuckled. “No thank you.” If she could, I'm sure she would have punched me in the face at this point.

The experience served as a pointed reminder of how disorienting and difficult everyday life can be when you don't understand the lexicon. The shoe was on the other foot a few days later, during a conference, when I attempted to explain the heat sink phenomenon in radiofrequency ablation to a group of our residents. I used what I thought was the perfect analogy: trying to sweat copper pipes with water in them. If you've ever seen or tried to do this, you quickly realize it doesn't work. Plumbers typically place a small slowly water-soluble bead or piece of squashed up bread into the pipe to prevent the water from getting near the flux (the plumbing equivalent to the Pringle maneuver). I received a collective and uniform series of blank stares from everyone in the room. I asked how many people knew what “sweating copper pipes” meant. I should have asked, “How many of you have walked on Mars.” Same answer: no one. Spoiled, entitled residents probably never mowed a lawn either.

Communication, or lack thereof, remains one of the biggest obstacles in medicine. Physicians and patients struggle with this every day. For example, how do you obtain informed consent from your average patient when the language of medicine was designed to confuse anyone who hasn't gone to medical school? From a patient's point of view, it's like having a contractor explain how he is going to fix the ductwork in your house…in Gaelic. My problems with communication even extend to the new voice dictation system in my department. Admittedly, I tend to mumble sometimes which doesn't help. Nonetheless, even when I don't mumble, this system has some serious issues. For example, it uniformly substitutes the word, “hepato pedal” for “hepatopetal.” Does it think the liver is a bicycle? Worse, the word “descending” is typed when anyone says “ascending.” The only way to describe a type A dissection is to say, “the flap extends into the ass-ending aorta” which defies my knowledge of human anatomy.

In my IR section, we routinely call referring physicians, discuss results, document the call in our reports and have our final reports signed in the electronic medical record within minutes of completing procedures. Amazingly, we still receive complaints about our “lack of communication” which supports the adage, “if there isn't anything to complain about, people will make something up.” I've been told that the latest improvement designed to improve communication is asking the person on the other end of the line to repeat everything you've just said to ensure they understood what was discussed. This could work. On the other hand, I could also repeat the word “tharschted” and still have no idea what's going on my sandwich.