I agree that our bedside manners with patients need some rejuvenation. It’s not fair, however, to isolate this issue out of context. Physicians today are facing crunching pressures from various sources that we cannot always compartmentalize when we are facing our patients – even though we should. Most folks believe that the bedside manners of the prior generation of physicians were superior to ours. Were our predecessors simply more compassionate and caring human beings than we are? I don’t think so. I think the medical profession was a different beast then. I hypothesize that if these wizened physicians entered the profession today, that they would behave differently.
Context is so critical when examining any issue. Many physicians find today’s patients to be demanding and entitled. Again, before pronouncing a verdict here, there are reasons and explanations behind this that need to be aired. Patients and physicians are both different today because the culture and nature of the profession has changed. How would Marcus Welby behave if he weren’t making house calls with a black bag 40 years ago, but were now an employed physician in a large clinic who was sued every few years and whose medical ‘quality’ was monitored by bureaucrats who determined his reimbursement?
Again, I’m not excusing deficient bedside manners, but the issue has nuance and complexity.
A Chicago couple, Matthew and Carolyn Bucksbaum, believe that bedside manners are worth a lot. These philanthropists are donating $42 million to the University of Chicago which will create an institute under their names which will be devoted to teaching medical students good bedside manners. The hope is to ingrain values of compassion and empathy deeply enough into medical students that they will not be contaminated when they enter the medical arena later. The training would function like a suit of armor to protect young physicians from bedside manner decay and attack.
This is a fantastic initiative and I hope that other donors and medical institutions emulate the Chicago program. While medical schools do teach bedside manners and the importance of the doctor-patient relationship, it was undervalued, at least in my day. Younger physician readers can comment if times have changed.
Can you really teach compassion or do you have to be born with it? A Chicago couple has wagered in a big way that it’s nurture, not nature.
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Frank Davidoff addresses this general topic in his wonderful little essay: "Music lessons". I would link it but it is a members only page at the AIM.
I'm still trying to sort my opinion of "boutique" medicine. I have trouble moving beyond the "pay me extra and I'll be nice to you" aspect of it.
I totally agree with you that times have changed and physicians 50 years ago are practicing in a totally different environment than now. Bedside manners and compassion are 2 different things though. I think my bedside manners are pretty good, but I admit that I struggle to have compassion for many patients. As I've mentioned in previous comments, more and more patients these days have illness that are due to their own lifestyle, that is, self-inflicted. How do you have compassion for someone who has lived a lifetime of poor decisions and is now having medical problems directly related to those decisions? I don't know how many times I've seen patients with 40+ pack year smoking histories now with end stage COPD or lung cancer, and continue to smoke!
I'm not saying that these people shouldn't receive treatment; they definitely should. but for me, compassion is much easier to have when dealing with a patient that didn't have a hand in causing their own health problems
Hi Michael,
I like this post and its ambivalence on "teaching" bedside manner. Some doctors "get it right" by nature. But instruction can up their skills further, or identify interpersonal lapses that aren't self-recognized. As for those for whom professional, warm and respectful dialogue with patients doesn't come easily, instruction can help.
tired resident,
How many of us don't have problems of our own making (and not just in the physical sense). The human condition is imperfect. To expect otherwise is to limit yourself and your capacity to give as a physician and human being. Compassion comes from understanding our own limitations as well as others.
Great comments appreciated. While it seems to me that compassion and empathy originate from an individual, I realize that it is shaped by external forces. Physicians today and tomorrow have many more pressures and forces that can frustrate our ability to provide caring bedside manners consistently. It's a battle we can win, I think, but it's not a downhill coast.
It was once said about a certain doctor that "he invented concierge medicine before there was concierge medicine."
Instead of retainer fees, he was rewarded with donations to his center.
Doctors with no patience for e-patients may soon have no patients.
Healthcare reform is shortening office visits. Most patients are forced to research online prior to or following exams. These e-Patients range from passive to confrontational. Today's physicians need training in how to work with them and display policies so e-patients understand the boundaries.
From Duluth News Tribune
By Mark Stodghill, April 28, 2011
A judge threw out a lawsuit today filed by a Duluth physician who said he was defamed by a man who publicly criticized his bedside manner.
Dr. David McKee, a neurologist with Northland Neurology and Myology, alleged that Dennis Laurion of Duluth defamed him and interfered with his business by making false statements to the American Academy of Neurology, the American Neurological Association, two physicians in Duluth, the St. Louis County Public Health and Human Services Advisory Committee and St. Luke’s hospital, among others.
Laurion was critical of the treatment his father, Kenneth, received from McKee after suffering a hemorrhagic stroke and spending four days at St. Luke’s hospital from April 17-21 last year. Kenneth Laurion recovered from his condition.
In his 18-page order dismissing the suit, Sixth Judicial District Judge Eric Hylden wrote that looking at Laurion’s “statements as a whole, the court does not find defamatory meaning, but rather a sometimes emotional discussion of the issues.”
Hylden addressed the fact that Laurion posted some of his criticisms of McKee on websites. “In modern society, there needs to be some give and take, some ability for parties to air their differences,” the judge wrote. “Today, those disagreements may take place on various Internet sources. Because the medium has changed, however, does not make statements of this sort any more or less defamatory.”
Hylden concluded his order by stating that there wasn’t enough objective information provided to justify asking a jury to decide the matter.
Laurion was relieved by the court’s ruling.
“My parents, who are now 86, my wife and I have found this process very stressful for the past year, since my father’s stroke. There was never just one defendant,” he said. “We’re grateful that Judge Hylden found no need for a trial.”
In his suit, McKee alleged that Laurion made false statements including that McKee “seemed upset” that Kenneth Laurion had been transferred from the Intensive Care Unit to a ward room; that McKee told the Laurion family that he had to “spend time finding out if [the patient] had been transferred or died;” that McKee told the Laurions that 44 percent of hemorrhagic stroke victims die within 30 days; that McKee told the patient that he didn’t need therapy; that McKee said it didn’t matter that the patient’s gown was hanging from his neck with his backside exposed; that McKee blamed the patient for the loss of his time; and that McKee didn’t treat his patient with dignity.
According to the Minnesota Board of Medical Practice website, McKee has had no disciplinary actions brought against him.
“I’m very disappointed by this court’s decision because as far as I can see the only avenue that I can see that I had to respond to this overwhelming attack was through the courts, and for the time being it appears that avenue has been closed without me ever getting a chance to present my evidence,” McKee said.
McKee said he hadn’t had a chance to confer with Marshall Tanick, his Minneapolis attorney. He said he will do so before he decides whether to appeal the decision. Tanick told the News Tribune he had not yet seen the decision and couldn’t comment on it.
“Dennis Laurion is a liar and a bully and a coward,” McKee said. “He knowingly made false and malicious statements about me to a total of 19 different professional and medical organizations, regulatory agencies and websites. He often used false names and attributed his statements to fictitious third parties. I’ll make the observation that every one of those organizations that was required to make an official decision or take an official action either determined that the statement that he made was so ludicrous that it required no response from me at all or decided that his complaint had no merit.”
Summary Judgment:
http://www.onpointnews.com/docs/Mckee-v-Laurion.pdf
I have had the unfortunate opportunity to deal with many physicians in my life-time. I say unfortunate meaning having to be ill, and for the actual experiences with certain MD's. I had an amazing family doctor for many years, but unfortunately he had the audacity to pass away at a far too young age. (;) That man was extremely intelligent, intuitive, caring, nurturing and empathetic. Then I've had a surgeon, who came bursting into my hospital room, this was my first time seeing him ever, he yelled at the phlebotomist who was just getting ready to draw blood to get out of my room and come back later. He then proceeded to act like the most arrogant a hole on the planet while going over my rather complicated health history. He literally at one point made the implication that I was lieing about how many bowel movements I have in a week! Absurd. He literally had me in tears when he left. I told the nurse, who said he has that reputation, I then told the head of nursing about him and that I never wanted to see him again. The next day he came in when my husband and father were in the room, and had a completely different demeanor. Jerk. I know doctors work hard. I know they have crazy schedules. I know its stressful. I know there are difficult patients, who think they themselves know as much about medicine as the doctors do nowadays with webmd and whatnot. But, I also know, that we are all human beings, and doctors and nurses went into their professions knowing they would be dealing with people...all types of people...sick people...people who need care and compassion. What I don't get is, it seems so many people who are so obviously not "people persons" get into these professions...why? The money? The prestige? All I know is, being a disabled person myself, I am very appreciative when a medical person takes that extra sixty seconds to make me feel like they see me as a person and care about my condition. That's all it takes. And if it takes a dang class to make another human being show another human being who is obviously ill some compassion, then so be it, but what a sad and disappointing picture of our world that shows. I was a nurse. I've been on both sides. I took the time to show my patients I cared. It's not hard.
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