The French playwright Voltaire quipped, “The art of medicine consists of amusing the patient while nature cures the disease.” Of course, since the 18th century, a lot has changed in medicine, and today’s doctors have many more life-saving tools than their premodern predecessors.
There’s also a lot less time for care, said Dr. Steve Bush, a radiation oncologist with Mercy Regional Medical Center.
“With the industrialization of medicine – the emergence of big, big clinics – the mom-and-pop doctor’s offices of yesterday are gone,” he said. “You go to the doctor’s office and know you are getting a 15-minute slot.”
But he said as the science of medicine has advanced, bedside manner has grown more, not less, crucial to good doctoring.
Studies increasingly correlate a good doctor-patient relationship with effective treatments: If you want to lose weight, quit smoking or beat pneumonia, you’re more likely to succeed with a doctor you trust. Studies also have found an attentive bedside manner doesn’t just lend itself to better patient results – it helps doctors. Doctors who have a warm bedside manner are sued for medical malpractice much less frequently than their equally competent, if colder-hearted, counterparts.
“People who believe that they’ve been blown off or their problems haven’t been taken seriously are much more likely to be distressed and litigious,” Bush said.
Dr. Donald Cooke, an allergist with his own practice in Durango, said he occasionally sees patients who are refugees of indifferent care.
“People don’t hit it off with certain doctors,” he said. “I’ve seen it when new doctors come out of residency training. They often don’t have quite the right attitude toward patients – that comes from the hospital setting and long hours and being young.”
As long as the doctor is a fundamentally nice person, he said, he or she will quickly learn to more fully empathize with patients once delivered from the gruesome demands of hospital-residency training.
Trust is crucial
Dr. Michael McCallum, an anesthesiologist with Mercy, said though bedside manner isn’t taught in medical school, earning a patient’s trust is vital to every aspect of treating them.
He said because he typically sees patients before they’re put under for another procedure, he has mere minutes to establish a rapport.
“Every patient is different,” he said, “and what may have worked for you in the past may not work with other patients. If someone is about to get cancer surgery, their anxiety is high. If someone’s about to have a baby, they’re pretty happy. There’s no golden rule to it.”
He said a patient’s trust – or lack of trust – could have direct impacts on the effectiveness of a treatment.
People are naturally shy about disclosing their drug habits, he said.
“But if a patient uses a lot of recreational drugs, and I give them a typical amount of anesthetic medication to make them sleep, they may metabolize it a lot more quickly,” he said, meaning the patient risks feeling unnecessary pain.
“Once they understand that you want to help them, they want you to do your job safely. It’s pretty rare for patients to be completely obstructionist and withhold information once you explain it to them,” McCallum said.
He said it was easy to accidentally damage trust.
“The number of things going through your mind every time you ask a question is vast,” he said. “Shaking hands may be the wrong thing to do – suddenly you’ve ruined the whole environment.”
Asking tough questions
Part of the problem is the very nature of the questions doctors have to ask can leave patients feeling offended, belittled, scared or judged.
How much do you drink? How many sexual partners have you had in the last six months? How did you get those bruises? Does it sting when you pee? How long has your testicle looked like that?
How honestly patients’ answer often depends on their anxiety, and patients’ anxiety often changes according to the particularities of their medical circumstance. Were they just diagnosed with something grave? Are the going through a divorce? Are they in pain? Do they feel shame about their malady? Are they comfortable with the doctor’s vocabulary?
Bush, the radiation oncologist at Mercy, said by the time he sees a patient, they already have been diagnosed with cancer, so they tend to be less emotional and more resigned to treatment.
He said in general, emergency-room environments are most difficult because doctor-patient communication tends to be hurried.
He said even outside the emergency room, doctor-patient interactions can be pressured – especially first meetings. In return for getting a stranger’s help, a patient must confess their worst habits and their bodies’ greatest pains, discomforts and failings – within a brief conversation.
Bush said in cases where patients suffer illness as a result of a clear cause-and-effect – for instance, smokers who are battling lung cancer without kicking their cigarette habit – it can be difficult for doctors not to become frustrated. Their work conditions them to think rationally and save lives.
“Doctors are people too. They have a delicate role,” he said.
But he said the best doctors overcome the initial impulse to judge their patients and instead devote themselves to being supportive, recognizing that – while, for example, the science of smoking may be simple – humanity is complicated.
Talking to children
Pediatrics can often stretch doctors’ interpersonal skills. As children are often afraid of blood, shots, haircuts and strangers, the doctors who deal with them must be especially nimble.
Dr. Pakhi Chaudhuri, of Pediatric Associates of Durango, said she’s careful to respect her patients’ boundaries.
For instance, she said, toddlers don’t like making eye contact with strangers off the bat and prefer to case the office or room, paying close attention to how their parent interacts with the stranger before getting comfortable.
“They’ll usually scream if you get in their face,” she said.
Chaudhuri had similarly ingenious strategies for dealing with teenagers, who, as a group, are prone to feel paralyzing embarrassment.
“You do it in a roundabout way, to soften the blow developmentally,” she said. “Instead of asking ‘Are you having sex?’, you ask, ‘Are your friends smoking cigarettes or drinking right now?’, ‘Are they having sex?’ before asking, ‘Are you engaged in any of those activities?’”
She said she doesn’t lie to patients of any age and avoids using the word “hurt.”
“If a child asks ‘Will this hurt?’ I’ll say ‘This one will feel stingy’ or ‘This one won’t feel so bad,’” she said. “If you’re doing something that hurts them, reassure them it’s almost over. But don’t lie, that breeches their trust.”
Long-term relationships
Cooke, the allergist, said he benefited from long-term relationships with patients, who often come in once a month for shots.
“People can get so much stuff off the Internet. It’s very confusing,” he said. “I think a part of our job is to go through things and calmly reassure people about what’s pertinent and what’s not.”
He said establishing a personal relationship with the patient was integral to providing quality medical care.
“If I just went from one runny nose to the next,” he said, “it would be a very boring job. What’s important isn’t whose nose is running, but what their family is like, what work they do – the patient’s story.”
cmcallister@durangoherald.com
