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The art of pitching in medicine

If you are a health professional a lot of what you say will be an attempt to pitch to the patient. I forgot to keep that in mind as I broke the news that Hilda had diabetes. Her husband sat bolt upright next to her looking concerned at the mention of ‘diabetes’. I casually asked:

Me: What do you like to eat?

There was silence.

Me: Do you like bread or potatoes?

Him: Yes! She likes lots of bread and potatoes!

Poor Hilda looked like Christmas was cancelled. I knew then that her devoted husband would make sure she didn’t get to enjoy any of her favorite meals and she looked like she just wanted this meeting to end.

A pitch is successful if your ideas get past the Amygdala and through to the neocortex where the information may then be classified as ‘new and interesting’ enough to warrant a second thought. In Hilda’s case the information would simply elicit a flight or fight reaction. When she got home she would argue bitterly that bread and potatoes were not the source of her trouble and that may be she’d prefer to see another doctor. Meanwhile her diabetes would remain problematic. If we don’t pitch effectively we don’t get the best outcomes. For people with coughs and colds we pitch for time, knowing that the symptoms (though horrible) will get completely better. For those like Hilda with a long term illness we pitch for them to make different choices and for those with a life limiting illness we might pitch for surgery and other invasive treatments.

I don’t remember being taught how to ‘pitch’ during my training decades ago. It is often assumed that simply giving people ‘information’ does the trick. But of course our words, when they don’t penetrate to the neocortex, are relayed and potentially reframed by family and friends, or dissected with reference to Dr. Google. That means we fall short repeatedly unless we consider what we say and how we say it in similar circumstances.

Hilda needs her bread and potatoes- I was determined that we would come to a shared understanding of her problem and that the ban would be lifted sometimes. Fortunately in primary care there is that option in most cases. It might also be worth learning the art of pitching from others who do it for a living in three minutes.

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