Guy Talk

One of the first challenges I faced as a foreign doctor from an urban background practicing in a small town in this country was finding the right way to explain medical issues to my male patients. They were farmers and fishermen without much experience with illness, medications or medical procedures. Most of them came to see me reluctantly at their wives’ insistence.

Gradually, I found my voice and a style that has served me well over the years. As a Boy Scout and grandson of a farmer with more than an average interest in automobiles, I have found enough analogies from my own experience to be able to cross the cultural barriers I have encountered in my new homeland.

I may explain risk aversion by talking about why some men wear both a belt and suspenders. Heart attacks and angina are, obviously, related to plugged fuel lines. Beta blocker therapy is similar to shifting your manual transmission into fifth gear. Sudden discontinuation of beta blocker therapy is like releasing an inadvertently engaged emergency brake while driving with your gas pedal fully depressed. Untreated hypertension is like driving down the highway in third gear, and orthostatic hypotension is a lot like getting poor water pressure in an attic apartment.

Other, perhaps less obvious, analogies I have perfected over the years include the following:

Finasteride to slow progression of benign prostatic hypertrophy:

You buy a new car and the dealer sells you a rust proofing job. Five years later, your car is rust free. Is it because you paid extra for the rust proofing, or would the car have been OK anyway?

Why carotid artery stenosis up to 80% can be asymptomatic:

If you water your plants with a garden hose and compress the hose by 80%, the water will actually squirt faster and further than if you just stand there with a soft grip on the hose.

What to do when a test result and your judgment conflict:

When the terrain and the map disagree, follow the terrain.

Why some people with high cholesterol escape heart disease while others get more atherosclerosis than expected because of inflammation, as measured by C-reactive protein (CRP):

Some people’s arteries are like Teflon, nothing sticks, and other people’s arteries are like a scratched-up aluminum pan, everything sticks to the bottom.

Why skipping just one dose of your antihistamine can cause a major allergy flare-up:

If your townspeople are trying to discourage out-of-towners from stopping in and causing trouble at your local hangout and your strategy is to make the place look filled to capacity, be sure you get there as soon as they open, and don’t you all take a break at the same time, or the place will look empty and they’ll be sure to stop in.

Why some people can take an antibiotic several times before they get a rash from it:

Just because your neighbor’s pit bull doesn’t bite you the first time you see it, do you really know it won’t bite you the second time?

Our job as doctors is to meet our patients “where they’re at”, as people say around here. That’s not the English I learned in school, just like the explanations and analogies I use with my patients aren’t exactly the ones I learned at Europe’s second oldest university. But all the book knowledge in the world won’t help you be a better doctor if people don’t like or understand the way you speak.

Today, a nurse I work with at the nursing home gave me the nicest compliment. Her husband had, reluctantly, been in to see me a few weeks ago. She told me that her husband thought that now, for the first time ever, he had a doctor he could talk to – one that talked the way he did and laid things out plain and simple without putting on airs or making things complicated.

Comments like that always make my day, just like hearing that people forget I am a foreigner and “from away”.

1 Response to “Guy Talk”

  1. 1 isaac November 21, 2010 at 2:16 am

    I’ll have to remember some of those.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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