Thursday, September 07, 2006

"The way the doctor talked to me made me want to kill myself."

Part of what I love about med school - even only a few days in - is that they're already teaching us how to be doctors.

It's a nice change from undergrad. When I studied science in my undergrad, we only really learned the science. Now, we have classes that teach us the scientific background, obviously, but they're much more applicable to the clinical setting - we learn about the pathology, the pharmacology, and so forth.

Better still, there are also a number of classes that could be summarized as belonging in the 'how to be a doctor' category. We have a course in clinical skills where we get the chance to learn how to take blood pressure, start IVs, stitch wounds (our school just started a new policy that the first time students practice suturing we are not allowed to do it on a patient), and practice injections on oranges. We'll be going into doctor's offices in just a couple of weeks to start interviewing patients and giving them injections. And we're taking classes on how to talk to patients, which will involve us not only learning the principles in lectures and small groups, but also being evaluated as we interview real and simulated patients (actors).

We had an excellent speaker today to open up our class on bedside manner / talking to patients. Even though he has five degrees, the one thing that is always highlighted when he is introduced to speak is that he has been on Oprah. He has interviewed thousands of patients for studies, and through that gained insight on iatrogenic suffering, meaning any sort of illness or suffering caused by the medical profession. "The way a doctor talks to a patient can cause more pain than the disease itself," he told us.

We were told a few examples of 'horror stories' of doctor/patient interaction, which most people hear about every once in a while. Here are a few of the ones he mentioned:

  • "They decided to remove the lump anyways, even though they told me months ago it wasn't cancerous. As I was just starting to wake up after the surgery, the doctor came to my room and told me from the doorway, 'We made a mistake, it's cancer.' I was horrified that he would tell me in that way."
  • "The doctor was talking outside the room and joking with someone else about a movie they'd just seen. Then, she came in and told us that our baby was dead. That's it. No intro or anything. Even though we were only 20 weeks along in the pregnancy, we had been trying for so long and were so excited. We knew it was a boy. We'll never go to this doctor again."
  • "The way the doctor talked to me made me want to kill myself." Or, "After the doctor talked to me that way, I left his office and tried to kill myself."

Scenarios like that are the justifications they use for teaching us how to talk to patients, and clearly a course of this nature can serve some very important functions and is well-warranted. I'm not sure how long such courses have been around, but according to some articles I've read they're pretty new. Obviously they'll teach us important things about bedside manner, which we'll begin to use right away.

The thing is, pretty much anyone reading the above scenarios - even medical students and practicing physicians - would be shocked at the blatant disregard for patient dignity that the doctors allegedly displayed in these instances. I'm sure that even the doctors who committed those actions would be shocked when it was put in a statement like that. As a result, the above can only be explained by some sort of a desensitization that occurs in physicians after they have seen hundreds of thousands of patients, a desensitization that causes doctors to do the above things without even being aware of it.

There are obviously clear benefits to holding these classes. However, I don't think we'll know the extent of how effective they are for a long time, becuase I guess the real test of these classes is to see if they are still influencing the way us future doctors practice medicine 20, 30, or 40 years from now. If, decades down the road, they have been and continue to be successful in preventing such scenarios, then they will have turned out to be a good idea. Until then, I suppose we won't know if doctors should be taught bedside manner in some other way.


2 comments:

CharleyBrowne said...

i found the real life patient speaches really cool and inspiring too! And if you haven't done the SP interviews yet, it's super fun but not as easy as it looks at first!

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