It was inevitable. Some of the questions I redirected to Dr. Google--when it's specific side effects of a particular medication, I do not have a complete compendium of these in my head as of yet though some important generalities are firmly lodged in place, such as NSAIDs and gastric bleeding. Other questions that are more general knowledge or things that I took for granted as general knowledge, though, I've answered a number of these. I had only completed my program by a couple of days when I received a call from a family member asking whether they should go to the emergency room (after gathering a bit of information, I suggested PromptCare if X and Y did not improve by Z or go to the ED if there were life-threatening symptoms like trouble breathing). I've had a couple other friends ask, receive permission, and then send me pictures of different parts of their body. I've looked at weird skin spots. I've explained the mechanism of action of various medications. I've explained what to expect as a loved one regresses further into dementia. I've re-explained procedures that were only half understood after doctors' appointments setting them up. These and more, I understood that the questions were inevitably part of the territory.
As happy as I am to help, I am more cheerfully helpful when persons check for permission first. It's an important boundary check. However, I won't deny that I am happy to teach where I can teach. I like sharing the information I know, to flex those pieces of knowledge to help someone else (while still adding the caveats that I'm not a replacement for keeping their doctor appointment).
And that has to go in reverse, too: I have to check before I jump in with unrequested information. Sometimes someone is just venting and not asking for medical advice. There have been conversations where a loved one was hospitalized or diagnosed with some kind of condition and it's as though the password was spoken and my empathy is overshadowed by overwhelming curiosity. I want to ask what medications have been tried, have they approached the topic of X or Y therapy, what were the last lab results on Z, have they also experienced Q symptoms, etc. I have to stop myself, though, when I realize that my curiosity is not necessarily productive to the conversation. I have to know when to flex the knowledge that I have.
This can get especially tricky when I'm at work. When I'm clocked in, I have given implicit permission to be asked medical related questions. Hell, we have set reminders to chart education, meaning that I am expected to offer it at the very least daily, not just the information dump before discharge. But the family member who just signed their loved one into hospice, they aren't interested in how the body will mechanically deteriorate at the moment--their questions of "when are they going to die?" are more about coordinating with the family and finding their own processing space. Factual and practical information could be soothing or it could induce more anxiety. Or more confusingly, there can be a balance of information that is helpful before tipping over from empowering to overwhelming.
There isn't a magic formula to know how much information is too much--it involves a fair bit of guessing and gentle prodding. I try to ask questions along the way to ensure that the party is open to information or otherwise start with where their questions are, titrating information in pieces as I see them throughout the day. One of my favorite questions especially during discharge instructions is "I just threw a lot of information at you: what can I clarify?" This firstly acknowledges and validates any feeling of overwhelm. It's also an open-ended question, meaning that there isn't a space for a simple, placating yes or no. Sometimes we cover the same information again; sometimes we're taking it a step further. I try to also end with a brief "if you remember anything from what I just told you, remember these three things," in order to bring to the forefront one more repetition as the final say.
Outside of work, though, there are spaces where the information I have learned is helpful and places where it is not. There are places where people demand it and places where forget that that experience can be a resource. This means putting out feelers for what is welcome without overstepping. It's the same process in offering any expertise, that balance between the excitement of knowing the answer and the awareness that "an answer" still may not be what the conversation partner needs in the moment. I've learned how to ask the questions that are indirect, probing for what someone might want from the conversation, but this still entails more guessing than I would prefer: as such, I'm growing more comfortable with directness. I asked a patient the other day, "Would you like to understand or do you just need to vent?" I've asked many times "How can I help you best?" whether I'm listening or helping someone with a task. At home, we are learning "That's not helpful right now," when someone is trying to fix something that we only needed a listening ear for. Sometimes whole conversations are preceded with a phrase or question to help indicate whether listening or problem solving is the goal--85% of the time, I feel, it's listening.
Sometimes I think I know someone or a particular inflection well enough to guess whether they want input or a listening ear, yet I've learned that it's okay to check even midway through, confirm those thoughts before there is accidental overstep. My knowledge base in my field will continue to grow, and I will actively be ensuring that my communication skills--particularly checking for consent and boundaries--sharpen along with it.
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