Importance of Bedside Manner

[shoe]

I would be very interested to hear how others feel a doctor's bedside manner influenced their illness for better or worse. Twelve years ago I had a very bad health scare. An ultrasound given to determine a cause for my high blood pressure, found tumors in my liver. I had a cat scan, what seemed like hundreds of blood tests, colonoscopy, hemangioma scan and then a biopsy. The cells were sent to Cleveland Clinic and came back "inconclusive". The Gastro guy, a very smart man, said that I had schlerosing cholangitis and about 10 years to live. He said he was putting me on the transplant list and to prepare myself for what would be two transplants (I guess one never lasts) and that I would have to go to Omaha, Nebraska or Madison, Wisconsin. The entire time he was telling me all this, the little voice in the back of my head was saying "RUN!!!". How I made it out of that office on my own power I will never know. I became very depressed. I had young children and I was only 41.
At my next appointment with my regular internist he reassured me and said to let him handle it. Within 3 months my liver levels returned to normal and have stayed that way and I have had not one sign or symptom of disease. Since that experience I have often wondered if a doctor is aware of just how powerful his words are. It can make such a difference!

[Meadbh]

Speaking as a physician, I am truly sorry you had a bad experience, albeit I'm happy that your health has improved.

Effective communication (with patients and other healthcare workers) is central to a physician's job performance. "Communicator" is one of the seven key roles on which subspecialty residents in Canada are trained and evaluated. See CanMEDS. Recent research shows that a physician's likelihood of being sued is directly related to his or her aquisition of communication skills as assessed during training.

I am currently working with a resident who is in remediation because of inability to listen. He's getting plenty of support and guidance, but if communication doesn't improve, he will not be allowed to proceed to certification exams.

[dex]

I think you hit upon a very important aspect of life that is important is all aspects of life - the ability to listen well to all people around you. We are taught how to talk be we are never taught how to listen.
I learned the power of the ability to listen when I worked on a runaway hotline.
Listening is an active ability - not passive - it is more than just keeping your mouth shut.
Active listening - Wikipedia, the free encyclopedia

I put active listening in the catagory of "If I only knew then what I know now."

Meadbh,
Listening take teaching by a professional During my hotline traing a psychiatrist came to speak to us. She told her story about having breast cancer and how when she said she was afraid of dying others said to her - "you'll fight it; you'll be OK, etc." It wasn't until she was speaking with her psychiatrist and told her about her fears her psychiatrist said "yes, you might die" that she was able to begin to deal with the cancer.

If there is a good runaway hotline near you maybe the resident could observe and see the power of active listening.

[Nords]

Quote:

Originally Posted by dex I think you hit upon a very important aspect of life that is important is all aspects of life - the ability to listen well to all people around you. I learned the power of the ability to listen when I worked on a runaway hotline.

Our teen really wishes we'd be a bit less active in our listening. She's pretty good at answering the questions she wish she heard instead of the ones we actually asked...

[MikeD]

Quote:

Originally Posted by shoe He said he was putting me on the transplant list and to prepare myself for what would be two transplants (I guess one never lasts) and that I would have to go to Omaha, Nebraska or Madison, Wisconsin.

As a kidney/pancreas transplant recipient, I spend a lot of time at the transplant clinic where all types of transplants are discussed, especially during educational seminars. I have "heard" that liver transplants recip's often need kidney transplants 10 years after the orig liver xplant. Something about the drugs/liver combo kills the kidneys.

Mike D.

[Achiever51]

This thread really hit home for me.

In 1995, my DH suffered a heart attack while I was out of town on business. With no flights available, I rented a car and drove like mad to the hospital, arriving at around 2 in the morning. I was brought to the cardiac ICU where he was being cared for and there I met the cardiology fellow from hell.

While trying to just take in what was going on, standing near my husband's bed -- with my DH sedated, but still awake, I asked the doctor (who had not even introduced himself) about my husband's condition. Doc's exact words were: "Well, we'll see. You have a one in three chance of becoming a widow by the time the sun comes up. He should have taken better care of himself."

With that, he walked out of the room. I watched as my husband's vital signs jumped all over the chart -- then, I followed the doc to the nurse's station. I asked him why he made that statement -- and particularly why he chose to say that in front of my husband -- and the doc said something along the lines of "I don't believe in sugar coating this info. One in three patients die from heart attacks and you might as well be prepared."

The nurse at the desk was as stunned as I. When Dr. Sensitive walked away, she came to me and comforted me. I asked for the Doctor's name; she told me that he was a newly minted cardiology fellow who had brought many other spouses to tears with his tough love approach.

After my husband recovered fullly -- and thank God, is still with me and doing fine, thank you! -- I filed a formal complaint with the hospital's physician review committee. As a result of my (and others') complaints, the hospital instituted a whole program about communication with patients and their families. It has made a world of difference, I'm told.

[SecondCor521]

More from the patient's side of things, I think it is very important, in situations where you feel you have an issue with a doctor, to address it in some way or another rather than letting it slide or trusting the doctor or bowing to the doctor's "authority figure" status. Talk with the doctor, get a second opinion, or something.

I had a condition once and went to a specialist for the problem. He told me it was probably nothing and it would probably resolve on its own. I didn't think he was right so I asked around, found the best specialist on this subject in the area, and went to see him for a second opinion. Good thing I did, as he diagnosed the condition properly and I spent the next five years clearing it up.

To all the doctors out there, I'm not saying that patients should be obnoxious know-it-alls trying to play doctor themselves with help from the Internet and googling their symptoms and telling you that you don't know anything. I'm just saying that patients should take an active role in their care and that they should make sure they get their questions answered to their satisfaction.

2Cor521

[shoe]

As a patient reliant upon a doctor's expertise, it would be more than enough to have a doctor tell me that he would do his best for me. I don't need doom and gloom even though it may be ever present. I need some kind of hope to hold onto. Something bright in a dark room. We are all big boys and girls by now, fully aware that life is a crap shoot and that a doctor is not God.

[Walt34]

Perceptions differ widely on this. I was with DW talking to her doctor, she was very upset about an issue that was potentially serious, and he (I thought) was simply being factual about it.

We ended up talking about the encounter for a couple of hours. She thought he was being insensitive and callous to the point of changing physicians, and I didn't see that he did anything out of line.

Same discussion, perceived entirely differently.

[CuppaJoe]

It certainly can increase the stress level. Years ago, a doctor called to say I had a mass that "ultimately would have to come out." I set up an ultra-sound and got a return call that the appointment had to be changed because they don't to ultra-sounds on (another part of the body) at that time of day. That is how I found out I needed two separate surgeries. These things are very upsetting, but in the scheme of things, what is important to me is that this same organization has saved my life several times, including the ultra-sound incident; the doc was right, it really did need to come out.

[poboy]

I was talking to a doctor in the hospital several years ago and two residents walked by. The doctor said that one was going to be a good doctor and one was going to teach. I asked how he knew and he said he had sent them to get a patient to sign a release for an exploratory procedure. He said the first resident started using those $50.00 medical terms and phrases and the patient said he was not going to sign. The second resident said that this is a test for cancer, it might be the eating kind and we need to find out. He said the patient said I'll sign that.

[figner]

Quote:

Originally Posted by poboy I was talking to a doctor in the hospital several years ago and two residents walked by. The doctor said that one was going to be a good doctor and one was going to teach. I asked how he knew and he said he had sent them to get a patient to sign a release for an exploratory procedure. He said the first resident started using those $50.00 medical terms and phrases and the patient said he was not going to sign. The second resident said that this is a test for cancer, it might be the eating kind and we need to find out. He said the patient said I'll sign that.

(only half kidding) So which one was going to teach?

[simple girl]

Bedside manner is also incredibly important for nurses to remember. My father has been in the cardiac care unit now for 2 1/2 weeks. Those nurses who take the extra time to talk to family really do so much to heal our hearts as we worry about our father. We've met some incredible nurses, and I always let them know how much we appreciate them. Some really go above and beyond. Unfortunately, there are a fair number who are so busy that they buzz in and out of the room and are very short with us when we ask questions. This makes you worry about the kind of care your loved one is receiving when you aren't there. There's so much more to health care than giving meds, monitoring vitals, etc. I wish those who have lost the "care" part would get out of the profession.

[ls99]

Little over ten years ago had some problems, primary doc could not figure out, gave me names of three dermatologists, said he likes xxx.

Went to see the fellow, he was in his 70's. Did a through exam, said: I don't know what it is, but will find out. After some preliminary topical treatments thing got worse. Did biopsy, bloodwork. Results came back. (I'll not name the illness. If you really want to know, use PM, if you are MD ) By the way there is no known cure for it. Doc says, I'm still not sure, how about coming in for Grand Rounds. I said: what the heck is that. He explained. I showed up.

If you never been to one it's a circus from the patient's point of view.

They post basic workup outside your cubbyhole.

From the collection of first year giggling junior med students, through various years of med students to residents, retired docs, and anyone else in the medical field. Word was out, most docs see one case maybe in a career. This particular doc recalled hearing about it in med school.
Grand rounds over I left, saw the doc a week or so later, he said, the discussion at grand rounds consensus confirmed his diagnosis. By the way, in my opinion, during this grand rounds, the most through and best exam was conducted by a first year resident.

To make the story short, after a limited time of steroids, he choose a very old and simple med, gave me guidelines on how to proceed.

This was the one of two cases he saw in his long career. The second case showed up in his office about a year after me. Then finally after four years of treatment, he announced: I can find no indication of the problem, can see no medical reason for continuing with the meds. If later you have a problem call me.
Five years later no symptoms. No calls.

The bottom line, He was the first doc ever to admit initially the he did not know. He did use superior reasoning skills, asked for extra opinions. Choose a course, kept me fully informed at all times. I did a godawaful amount of research on my own, mostly reading scarce research publications, ignoring all the drivel that is internet opinion. He helped me to understand concepts that I read but did not understand. If the site did not have .org ending, it was filtered out. Understanding is key to solving problems. I learned far too much medical stuff, hopefully I can forget and never use again.

As for support groups which were suggested. I refused: I did not want to listen to many versions and solutions. The single and only objective was to get well. And I did. Then the doc retired from practice, teaches a few days a week as a giveback.

[citrine]

I think bedside manner is extremely important.
I have not had the pleasure of being in a hospital bed as of yet....but my primary care physician is absolutely amazing. He actually sits down and talks to you and follows up to see how you are doing. I have never felt rushed or stupid. He is awesome!

[Meadbh]

Quote:

Originally Posted by simple girl Bedside manner is also incredibly important for nurses to remember. My father has been in the cardiac care unit now for 2 1/2 weeks. Those nurses who take the extra time to talk to family really do so much to heal our hearts as we worry about our father. We've met some incredible nurses, and I always let them know how much we appreciate them. Some really go above and beyond. Unfortunately, there are a fair number who are so busy that they buzz in and out of the room and are very short with us when we ask questions. This makes you worry about the kind of care your loved one is receiving when you aren't there. There's so much more to health care than giving meds, monitoring vitals, etc. I wish those who have lost the "care" part would get out of the profession.

I hear you. Unfortunately due to the ER of Moemg and many other RNs, there are bigtime nursing shortages and many nurses are very overworked. Some of those nurses you met might have been on their second 8 hour shift in a row. Right, Moemg?