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March 21, 2018

“Problem-solving”…?

By Victor M. Montori

Submitted by Dorothea Lagrange

I am a practicing physician in Sweden, where I have lived for many years. Often, I travel back to my home country of Germany and during my travels I enjoy looking at postcards. Most are quite funny, but sometimes beyond the humor is a message more profound. My favorites involve problem solving. Take for example these three:

Wenn das die Lösung ist, will ich mein Problem zurück!

If this is the solution, I want my problem back!

Ich habe keine Lösung, aber ich bewundere das Problem.

I don‘t have a solution, but I admire the problem.

Ich habe eine Lösung, aber sie passt nicht zum Problem.

I have a solution, but it doesn‘t fit to the problem.

This last postcard reminded me of my own experiences of care where the solutions people came up with did not fit the problem I was facing.

Some years ago I had an operation to my thyroid gland. Despite the surgeon’s confidence that he avoided damage to the laryngeal nerve, I experienced several complications. I could not talk above a whisper, I could not speak for long periods of time, I couldn’t even walk and talk at the same time. On top of all that, I would get breathless with even the slighest exertion and I had difficulty drinking without the fluid going down the wrong way!

I was devastated! Unfortunately, my well-meaning friends did not always help; their solutions did not fit the problem I was experiencing.

Some talked louder – but there was nothing wrong with my hearing.

Some talked in simple sentences – but my brain was still working alright.

And someone even switched into English. I am aware of my accent – but that didn’t get any worse, and normally my Swedish works just fine.

Thus, with the best of intentions, all these people had spontaneously come up with solutions without analyzing the problem first, and that can hurt.

It hurt because they did not see me as I am, someone with a well functioning brain, who could speak Swedish and hear just fine. Their assumptions about me distanced me from them and made me feel as Susan Sontag once said as part of the „kingdom of the sick“. Luckily, I recovered fully and I am now able to work as a GP. However, my experience with illness  taught me about the importance of listening. Even if it is a few extra seconds, the extra time spent determining the problem before jumping to a solution is invaluable.  In everyday consultations, our diagnostic thinking and our intention to find solutions starts directly with the patients’ first words. Physicians on average, interrupt patients within seconds as they rush to find a solution. We should let the patients tell their story. This is not only respectful, but may also help us diagnose the real problem facing the patient. As William Osler is purported to have said „ Listen to your patient; he is telling you the diagnosis“. Additionally, we have to see the patient as a whole person with the illness being only a limited part of him or her – and that part needs to be defined before suggesting or trying out solutions.

My name is Dorothea Lagrange. I was born and raised in  Germany and that is where I trained and began my medical  career. After taking a long time off to start a family, I got back into medicine and I currently work as a general practitioner in Sweden. I love my work and I work with fantastic colleagues and wonderful patients with diverse backgrounds. In addition to being a physician I am also a mother, relative, friend, and a patient myself – all roles which give me different views of medicine and health.

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Lovely insight!

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