Monday, May 28, 2012

THE REAL BEDSIDE MANNER


A May 12 Toronto Star article by Lorianna De Giorgio says,

“Bad bedside manner—when a health-care practitioner fails to see the patient as human—can make or break an already complex relationship. Patients crave a deep relationship, full of empathy and trust, with their doctor or nurse. Such a relationship, however, is sometimes lacking in the medical field. Patients complain that doctors or nurses sometimes talk down to them, forgetting they have a family, feelings and concerns. What is the psychology behind a bad bedside manner? And is it a conscious or subconscious decision by the doctor?”

Ms. De Giorgio has hit on a central issue. When I hear complaints from patients, they’re almost never about healthcare’s admittedly awesome technology, but about its lowest-tech aspect, communication. Bedside manner is more than not talking down to patients, though. We’ve all but forgotten what it actually is because it’s been parked in the shadow of the MRI machine for so long. Here’s what bedside manner is: helping others to feel better with one’s presence alone.

Some people are born with this quality. For the rest of us, though, it’s a skill, meaning it improves with practice. We begin to learn it when we recognize sick people aren’t just diagnosis-labeled organisms, but suffering souls as well. We’re talking about compassion here, literally “suffering with.”

No way around it: compassion hurts. Those of us who work daily with suffering must develop some strategy for addressing our own consequent pain. Traditionally, doctors are trained implicitly to repress the pain inherent in practice. As logical as that may seem, it doesn’t work. Buried pain is always buried alive. Look up doctors’ rates of divorce, drug dependence, alcoholism, and other sorrows. Male doctors have a forty percent higher rate of suicide than the general population, and female doctors an alarming one hundred thirty percent higher.

We docs can do better. We can behave like normal people, choosing to feel the pain already resident within us, express it, and even let it affect the way we practice. Of course, doing so might slow the great wheels of medical commerce, but so what? At least we’ll find ourselves healing our patients—and ourselves—along with treating them.

3 comments:

  1. This is a wonderful article, Jeff!

    Initially I was taught to treat people like a machine. Yet I found myself being emotionally involved. Over time I believe, that made me a better doctor, teaching be dammed.

    I did also find that I needed some time to emotionally recover, especially after exceptionally major cases.

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  2. Oh, Boy, my dear Jeff, you've hit it on the head again. Wish i had more time/energy/brainpower to respond but thanks for helping keep this issue front and center. It must change. Poor bedside manner can kill by discouraging conversation, challenge, honesty. Again, don't even get me started! Or please, do get me started. I need to walk among the living again.
    Big hug,
    Lori

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  3. Hi, Lori,

    So glad it struck a chord! And of course, it's not just you and me speaking about this. Here's the opening quote from my about-to-be-e-published book:

    "The rule books, I’m sure, frown on such intimate engagement between caregiver and patient. But maybe it’s time to rewrite them."
    - Kenneth B. Schwartz
    Founder, The Schwartz Center for Compassionate Healthcare
    (http://www.theschwartzcenter.org/)

    Thinking of you,
    Jeff

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