Making Great Conversationalists: Chapter One - Part Two

Before my son was born, I was a slightly-above average user of the medical system in the US.  I got an annual physical and a few same day appointments for rashes or various minor ailments that I was a bit concerned about.  Additionally, I'd need 2-3 urgent care visits for asthma, injuries or rashes that seemed to be going systematic.  (I'm a 21st level Eczema Goddess.)  About once every 5 years, one of my legs goes wonky and I return to physical therapy for a few weeks to a few months.

Since Jack's been born, I've become a medical appointment guru.  I've met so many specialists, generalists and therapists that I have difficulty listing them all.   Because of this, I feel plenty confident to discuss Steven and Teri Maxwell's odd take on "Making Great Conversationalists" at medical appointments.  Let's jump into the first "typical" example:

You are missing work to take your 14 year old son, Gerald, to a doctor because of a stomach ache he has had for the last week. You and he have been waiting in silence for 20 minutes, and now the doctor comes into the examination room.

" Hi, Gerald, my name is Dr. Grote. What can I do for you today?"

Gerald looks at you as if you were going to answer, but you nod so Gerald says, "Well, my stomach hurts."

" How long has it bothered you?" Doctor Grote queries.

" Well, I'm not sure, you know, ah, it's been a while," Gerald manages.

" It's a week yesterday, Doc," you add.

" Show me where it hurts and describe the pain."

" Right here, and it really hurts. You know?" Your son shows the doctor where it hurts.

" Would you describe it as sharp, aching, cramping, or throbbing pain?"

" Oh, maybe, no, let's see. I guess I'd say sharp," Gerald half mutters.

"Did it start quickly or gradually?"

" I don't know for sure." At this point, you are wondering what Doctor Grote thinks of your parenting skills when your teenager can't respond to him any better than this.(pg. 11)

Similarly to my critique of Cynthia's parent, the only person who is behaving neurotically in this sketch is Gerald's dad.  Personally, I foresaw that having children would mean taking them to a doctor from time to time - especially since minors need permission from a parent or guardian to receive most forms of medical treatment.  Similarly, if my spouse and I had more than one kid and both of us worked, fitting medical appointments into working schedules would require that the primary breadwinner would take time off every now and again for kids' medical appointments.  I feel like the queen of obvious for stating this - but parenthood brings mostly responsibilities and a handful of rights.  I know this - so why doesn't Steven Maxwell, the father of eight children?  His implication that Gerald's father has been greatly inconvenienced by taking his son for a needed medical appointment irritates the hell out of me.

Speaking of inconveniences - why is Gerald required to amuse his dad with conversation while Gerald's dealing with a long-term stomach ache? If I was nervous before a doctor's appointment, I tended to talk nonstop.  If I was actively feeling sick, on the other hand, I curled up into the most comfortable chair and tried to sleep until the medical assistant or doctor came in.   As I was typing this, I realized I'd never really thought of the amount of conversation I had when I was a waiting patient in a medical office.  My parents and spouse never seemed to care if I wanted to talk the entire time or attempt to sleep; they were fine either way.  This boggled my mind for a full minute before I remembered the obvious - none of us pride ourselves on being cut off from popular media.  If the sick person wanted to sleep, their driver would pull out a book, grab a magazine from the rack, enjoy the antics of healthy young children playing or watch the TV that was on.   There was no reason for the driver to be beholden on the sick person for entertainment (and expecting the sick person to do so would be viewed as childish, selfish or simply crass in my family.)

I am disturbed by the fact that a teenager still defers to his father before responding to a direct address from a doctor.  I went through a phase when I didn't know if doctors wanted to hear from me or my mom.  I was between the ages of 8-10 years old.   By the time I was a teenager, my parents had long convinced me that if the doctor addressed me that meant the doctor wanted to hear from me - not them.  Since married women don't work outside the home in CP/QF land, the parent accompanying Gerald can be assumed to be his father - and we can also assume that Dad hasn't been around 24/7 for the last week.    That's why I find Gerald's father's interruption to explain that Gerald's been sick for a week to be odd.   Gerald might have been sick for a week - or Gerald might have realized that he's been dealing with less severe, but similar symptoms for two weeks or two months.  That's why it's best to let the patient answer the question.  I've added additional information before when my husband (or parent) has been ill enough that I'm worried they missed part of the doctor's question - but that's pretty rare.

I highly doubt Dr. Grote has questioned the parenting skills of Gerald's father since Gerald's not showing any signs of abuse or neglect and Gerald is acting like a perfectly normal teenage patient.   Doctors know that patients come in a wide range of ability when it comes to describing symptoms.  It is so normal for the average patient to not know the answer to all of the doctor's questions - and doctors can make reasonable estimates of the answer sometimes.  For example, the fact that Gerald doesn't remember the sudden onset of severe, stabbing pain in a localized spot in his abdomen makes a decent case to assume the pain came on gradually.   I'm sure doctors like it when they can figure out most of the medical clues from the discussion with the patient - but the doctor also uses a physical exam as well as blood tests to confirm the doctor's diagnosis.

My final two cents - Gerald's dad is more worried about what the doctor thinks about the dad as a father than he is that his son has been having sharp abdominal pains for a week.  That's seriously messed up. 

Let's look at the "ideal" conversation:

Let's look at how the interaction could go if Gerald has learned how to talk to others, answer questions, provide information, and carry on a conversation.

" Dad, I sure hope Dr. Grote will give me something for the stomachache. I really don't want to miss choir practice tomorrow night. I already missed last week's practice."

" Son, I hope so too. What songs are you learning in choir right now?"

Your father and son conversation goes on for the 20-minute wait, and then Dr. Grote enters the room.

" Hi, Gerald, my name is Dr. Grote. What can I do for you today?"

" Well, sir, I've had this sharp pain in my stomach for the last week."

Dr. Grote nods and asks, "Why don't you lay back on the table here and point to where exactly it is hurting?"

" It's right here. It hurts the worst for about an hour after I eat. Then it is better, but it never really goes away. I have tried taking TUMS for it, but that hasn't helped. My mom thought I should try the BRAT diet which was bananas, rice, applesauce, and toast. I did that for two days, but there wasn't any difference."

Gerald's interaction with Dr. Grote is one with which you could be pleased. He answers questions, gives extra useful information, and is easy to understand. The time before the doctor came into the room was profitable fellowship between you and your son. (pgs 11-12)

See, Maxwell likes the second situation much more because the father gets entertained for 20 minutes followed by having his son perform well for the doctor.   Ironically, the conversation between the doctor and son has revealed less information in the second conversation than the first one.  In the first conversation, the doctor learns the place and severity of the pain, the fact that the pain has been around for at least a week, but possibly longer and that the pain came on gradually.     In the second conversation, the doctor has learned the position, severity of pain and length of time the pain has been present - but the implication changed so that the pain started clearly one week ago and nothing has been said about if it was gradual or sudden. 

  Now, Gerald offered a whole bunch of information about his eating habits and the effect on the pain - but not all abdominal pain is related to food.   I have this mental image of Gerald pointing at an area of his lower abdomen that could be related to things like his bladder, appendix or prostate while reciting how his family has been trying to treat that using the BRAT diet and TUMS.  (Added bonus that Gerald is a boy; a similar spot in a girl could be one of a dozen issues with the reproductive system.)

Throughout this book, the Maxwells include tidbits that show incidentally how isolated they've become from interacting with other human beings.  The example here is that Gerald feels compelled to explain the BRAT diet to his pediatrician or family practitioner.  Trust me; Dr. Grote knows what the BRAT diet is.  Dr. Grote is more than capable of explaining why the BRAT diet works well at quelling certain gastrointestinal issues - and why the BRAT diet will make other issues worse.  If Dr. Grote works in a diverse practice, he knows how to adapt the BRAT diet for recent immigrants who don't regularly eat applesauce or toast.    I remember my mom explaining the BRAT diet to me when I was a teenager in terms of teaching me a form of good self-care when recovering from a stomach bug.  The diet made a lot of sense to me - and I assumed that most - if not all - adults knew the rough outline of the BRAT diet. 

I hope you enjoyed this section as much as I did - the best is yet to come!  The next post is on when your son calls the father of the girl he's sweet on to ask permission to court.