Newsletter Monday
Hello Reader,
On my shift this weekend, I found myself explaining something to a trainee GP that I’ve seen play out countless times before.
It’s an example of the 'after effects' of communication in healthcare that I’ve seen before, many times in fact.
We saw a man at home who has been losing weight steadily since his surgery at the end of last year.
The operation on his bowel was planned and resulted in a section being removed and a temporary stoma being created.
He was expecting this; he’d lived with Crohn’s disease for decades.
But the unexpected part came weeks after his operation when he was contacted by the surgeon who said:
"We’ve got some good news and bad news.
The bad news is there was cancer in that part of your bowel. The good news is we have removed it all."
Now reading this you will draw your own conclusion about how that might have felt you heard it.
What I’ve witnessed many times over the years is that people don’t hear this conversation the way it sounds on paper.
Let me explain why.
The Rules of the Mind.
I have been a fan of Professor Steve Peters’ work for years now, as his model for simplifying the neuroscience of how the brain works has been transformational in my understanding of why we feel a lot of the things we do and why it can be hard to always operate as the logical, rational people we all know ourselves to be.
There is a section in his book, A Path Through the Jungle where he describes that the survival circuit in our brain that we are all born with — the part he calls the chimp — hears the music in a conversation, and the rational, more human part is what hears the words.
My patient heard the music from that surgeon.
The music kicked in at the word cancer.
If this had been a David Attenborough nature documentary, the slow tension-building rhythm would have started when he was walking to the appointment.
The big boom would have been when the word cancer was delivered.
The rational, human circuit in his brain couldn’t hear any words after that, because the music was too loud.
Think about when this has happened to you.
You might not have been in an appointment where cancer was mentioned, though I suspect many of you have.
Do you remember what was said afterwards?
Doubtful.
I suspect you remember what you felt though.
You might even be watching TV and an advert comes on for something that catches your attention. You didn’t even catch the words, but the tone and the "music" snapped you out of your daydream.
The survival circuit is quick. It has to be. It’s what kept us alive when we still roamed the earth in tribes.
Even actual music works this way.
We will know intuitively how a song makes us feel long before we’ve learned the lyrics.
I don’t know about you, but I have little brain space left for new song lyrics now. Yet the words to everything I listened to as a ten-year-old still seem to be deeply etched on my brain.
All of this matters because we are emotional beings, and thank goodness for that.
Otherwise we’d be nothing more than AI-powered robots, and I hope to God that day never arrives.
To be good doctors and healthcare practitioners, we need to appreciate this fundamental rule of how our brain works.
Just because an operation removed all the cancer cells, if that person had no idea they had cancer in the first place, don’t expect a heartfelt thank you and a box of Dairy Milk, dear surgeon.
You’ve just changed that person's whole worldview.
They will adjust in time, but it will take a lot of time.
This is what I spent much of the rest of the visit explaining to him.
How he felt was entirely understandable and normal given what he had been through.
The weight loss was also explainable thanks to the chemotherapy, the sore mouth, and the fear of "blocking the stoma", which was the other music he heard.
Learning to trust your body again takes time.
He will get there, but you cannot fast-forward it.
Which brings me around to the lost art of convalescence, but I’ll save that topic for another time.
Until next week.
