By Lauren K. Tormey, MD
Lauren K. Tormey, MD is an Assistant Professor of Medicine at the Geisel School of Medicine at Dartmouth and a member of the Dartmouth-Hitchcock Inflammatory Bowel Disease Center in Lebanon, New Hampshire.
Parents of young children know that there are many books out there about pooping. My personal favorite has always been “Everyone Poops”, by Taro Gomi. Through a combination of basic words and simple illustrations depicting humans, animals and poop of various shapes and sizes, children are encouraged to feel comfortable with the concept of pooping. With one goal in mind, “potty training”, suddenly parents everywhere are talking about poop.
But then, as soon as a child can wipe his or her own bum, there is silence: the conversation about pooping stops. As we get older, our childhood comfort with poop dissipates almost as quickly as it developed; talking about poop becomes “gross”, “disgusting” and “embarrassing”. In fact, my friend’s two year old has already started asking for “privacy” when she uses the potty.
And so it should come as no surprise that when I ask my adult patients what their poop looks like as an important part of their clinical history, I am often met with silence and fear-filled, anxious stares. This discomfort and language deficit around poop creates communication barriers that need to be addressed, typically within minutes of our initial office visit.
I’ve since learned not to ask my patients that question by itself. Instead, just as in the book “Everyone Poops”, I use a combination of simple words and images of poop (mine are from the internet) to start the conversation. “The Bristol Stool Chart”, a favorite communication tool of mine, provides seven images of various types of poop with plain language below it. I have even gone from “googling” the Chart, which took only seconds, to having it saved as a bookmark on my browser toolbar. It is right next to a link for the “Squatty Potty”, a creative version of a step stool that fits around the base of the toilet and helps adults who are having difficulties with defecation pass stool more easily. (I know some of you are googling “The Bristol Stool Chart” and “Squatty Potty” right now.)
With all of its dangers and pitfalls for patients including misinformation and information overload, the internet allows health care providers split-second accesses to millions of resources. Images illustrating some of the most complex and basic concepts, including poop, are readily available to me.
As I briefly explain the “Bristol Stool Chart” to my patient, I can recognize if she misinterprets it, which provides an opportunity for clarification. Then, I can be confident that we have the same definition of “diarrhea.” Or, I can learn that we don’t, and that she actually does not have diarrhea. This spares a potentially exhaustive, costly work-up and allows us to re-prioritize our time to focus on reassurance, education or other concerns.
Used in this way, technology is a valuable clinical tool to improve understanding. The technology can be cutting-edge or simple; the Internet is long past being a novel technology. The value of the technology rests not only in the design, but how it is implemented. Attempts to use technology simply to replace the health care provider will always be lacking.
Rather, some of the most successful technologic tools will be those that aim to enhance the physician-patient relationship, improving the ability of providers to deliver quality care. For out of the human connection grows humor and empathy, the foundation for trust and healing. My patient laughs at the images I show her, and I see her tension fade as she smiles. I’ve met her where she is, and we now we can truly start talking.