To Whom It May Concern:
Every time I speak to a group of med students I get the same question; “How are we supposed to be able to care for patients with respect and compassion when the system is continually pushing us for results, not quality of time spent?” It’s a good question and one I have come to dislike.
Yes, there is no doubt that our medical system is not set up for doctors to be personal therapists. Yes, they are under great pressure to do the job and do it quickly. I also think we have missed the point.
When it comes to patient care, one option is to sit down and have a heart to heart with great depth and emotion. Another option is to fake it. I don’t mean to fake the emotion, but I do think good patient care does not have to be the result of a bleeding heart. It also doesn’t have to mean canceling all of your afternoon appointments. Let me explain…
I don’t believe that the aspect of patient care that revolves around psychological wellness needs to be in depth or sincere. It can be as rehearsed as all the other doctor-speak taught in med school. It requires observation and practice, two skills that all doctors need no matter what. Here is my formula for “bedside manner”:
Step One: see the patient.
When I am upset about something, I don’t usually announce it. That doesn’t mean it’s not obvious, however! When doctors come and go and pretend as though life was a bunch of honey lollipops, it makes me more upset. I feel like I am invisible. That is a desperate feeling.
Step Two: acknowledge what you see.
If someone were to acknowledge that they recognize my emotional state would calm me down immediately. I would feel recognized and respected as a human being. Sometimes, this might be all I need.
Step Three: ask if there is anything that you, as the doctor, can do to help
Often there won’t be but simply asking is a sign of understanding and compassion (even if you’re faking it).
Step Four: set boundaries
This would be about the time that many patients would take up the rest of your afternoon spilling their guts (that’s because you’ve reached out to them and they trust you enough to let some things off their chest). Let them know you care (even if you don’t) but that you have an obligation to the other patients waiting.
Step Five: mirror
Paraphrase what you heard them say and let them know you understand how they could feel that way (even if you don’t).
Step Six: food for thought
Let them know you will mull over the things they have said and will get back with them if you think of anything helpful (even if you won’t). This is also a good time to give them names of organizations or individuals that specialize in this part of illness work. Giving them therapists or other support resources can allow them to feel they have left with something that might give some relief from the current emotional state.
Will this take longer than a normal visit? Perhaps, but not much.
Will this take an emotional toll on the doctor? Not if they learn this as part of a routine visit and can remain emotionally objective and calm.
Will this help patients feel as though they were being treated with respect and kindness? Most certainly.
Will this increase patient compliance? No doubt.
“Bedside Manner” training is quite in vogue. Medical Schools all around the country are implementing classes to teach doctors how to have more empathy for their patients. I believe this is an unrealistic goal. You can not teach a person how to feel anything. This will vary from personality to personality. With one individual it will vary from day to day. To attempt to reach this goal is to attempt to hit a moving target; it will happen on occasion but will usually be a miss.
When you are teaching scientific minds, wouldn’t it be best to teach a kind of compassion that can be consistent and logical? The truth is, a compassion that is genuine and a compassion that is manufactured are indistinguishable. As a patient, I would welcome either one.
Your med students do not have to graduate as Masters of Sympathy, as I once preached. However, I won’t give up on the fight for them to treat me like a whole being and not just a car that needs a tune up. Give them the skills, please, I beg you.
Thanks so much,