When Good Bedside Manner Becomes An Afterthought – Talk of the Nation : NPR

Medical schools strive to teach students the importance of good bedside manner in communicating with their patients. But sometimes, in the midst of examinations, paperwork and delivering difficult news, showing compassion can become an afterthought for doctors and nurses.

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Transcript

JENNIFER LUDDEN, host:

This is TALK OF THE NATION. I’m Jennifer Ludden, in Washington. Neal Conan is away.

Anyone who’s ever stretched out on an operating table or sat in an exam room waiting for the results of a test knows the importance of bedside manner, the way a doctor communicates the news, good or bad.

In a recent piece in the Washington Post, Dr. Manoj Jain writes that in the midst of examinations and difficult diagnoses, doctors often struggle to show compassion. This touchy-feely part of medicine, he says, has become an afterthought in patient care.

Doctors, nurses and patients, what are the challenges you face in communication? Our number is 800-989-8255. Our email address is talk@npr.org. And you can join the conversation at our website. Go to npr.org and click on TALK OF THE NATION.

Later in the program, we’ll look back at Oprah’s journey from small-town journalist to media mogul as the countdown to her final episode begins.

But first, bedside manner. Dr. Manoj Jain is an infectious disease physician in Memphis, Tennessee. He’s a regular contributor to the Commercial Appeal in Memphis and the Washington Post. Welcome to the program.

Dr. MANOJ JAIN (Infectious Disease Physician): Thank you, Jennifer, glad to be here.

LUDDEN: You, in your most recent piece for the Washington Post, you talked about how this issue came up when you had a conversation with one of your patients. Tell us about that.

Dr. JAIN: Sure. I was talking to Mike Penotta(ph). He’s a patient who had pancreatic cancer. And I was standing at his bedside, and he was having chills and rigors, temperature of 103. And sweat was dripping down his side, and I was examining him and talking to him, and I prescribed him some antibiotics.

But being there, I was wondering: You know, how can I show compassion at this very moment to this man who was suffering? I sort of thought about it, and then I realized I could do something.

I grabbed a washcloth from the cabinet, wiped his sweat, gave him some iced water – you know, these tasks which are usually, you know, relegated to the nursing assistant. And that got me thinking on this whole topic of compassion and what doctors and nurses can do.

LUDDEN: Now, is it this patient or another who you found out had actually been told some terrible news in quite a brusque way?

Dr. JAIN: Sure, it was this patient. In fact, what happened was his fever got better, and then a couple of days later I talked to him and I said: Would you be interested in talking about your end-of-life experience?

And I was doing a story on that. And he said very much so. He wanted to share his feeling. And I asked him a simple question. I said: When you were told your diagnosis of the cancer, what went through your mind?

And I was expecting the usual, the usual shock and denial and so forth. But he surprised me. In fact, he startled me. He said, and I’ll sort of quote him. He said: Well, the first thing I wanted to do was I wish I was 10 years younger. I would have reached across and slapped the blank out of the doctor.

LUDDEN: Oh my.

Dr. JAIN: Yes. And I sort of stood there, and I said: Why? And then he told me. And he said: You know, the doctor sort of came in, looked at his piece of paper, looked at him, and said this is terminal and then walked out.

LUDDEN: Ugh…

Dr. JAIN: Very, very painful and saddening. And that’s when I realized that this is something I should be writing about.

LUDDEN: You have a – we have a lot talk with you about. But let’s bring a caller in. There are people who have been on the other end of conversations like that.

Dr. JAIN: Sure.

LUDDEN: Let’s listen. Paula(ph) is in Durham, California. Hi there.

PAULA (Caller): Hi, can you hear me well?

LUDDEN: Yes, go right ahead.

PAULA: Okay, hello, nice to talk to you. I wanted to talk about my experience. I’m a breast cancer survivor and an ovarian cancer survivor. And my breast cancer treatment went very well, and I had a great doctor with that. I felt he was my teammate.

We discussed my drugs together. He told me about research, and we did a fine job together, and we beat it and with the help, of course, of my body.

But when I got ovarian cancer, you know, he was there for me again, and we worked together. I was diagnosed with this in 2004. And unfortunately I had a recurrence in 2006, and then something else happened in 2008.

And unfortunately after that the doctor moved out of the area, and I had a new doctor who came into his position. And I felt, you know, very confident, although I had had to retire from my job and I’d had a number of setbacks. And I’m pretty aware of the chance of ovarian cancer when you get it and the stage and your survival rate.

But I came in to meet this new doctor, and I said, you know, hello, nice to meet you, you know, welcome to our town, et cetera. And I said: Well, I had it was stage actually I was 3B I thought it was four(ph) -3B. But it’s been over five years. So I’ve beaten the 40 percent rate.

And he held up his clipboard in his hand and he said: Well, and he draws a line very firmly across the page. You were at 40 percent. And he scribbles 40. But at your recurrence – scribble another line – that made you 30 percent survival. And then he says: Then your other recurrence -scribble a line – that made you 20 percent survival.

LUDDEN: Oh my.

PAULA: And I looked at him, and I’m thinking: You’re not my partner in this. I just didn’t feel a sense of camaraderie with him at all. That doctor actually has since left our community. I think the whole community felt that same way, especially filling the boots of our other partner doctor.

And since then, I have a new oncologist, new to me. He’s been in town a long time. And again, I have a partner. He – I was in a clinical study. I’ve had to go out of the study because I had a growth and a tumor that just was resistant.

But I said: Well, how about this drug that I took last time? Well, that sounds like a good idea. Why don’t we combine it with that? And again, I had a partner.

And so although I’ve been really realistic, and he’s been really realistic to me about when he might have to talk to me about hospice, I’m so glad that I have a doctor like this who talks to me as if I’m intelligent and not lecturing a kindergartener…

LUDDEN: So it’s not that you don’t want straight-up, realistic information and can handle it. You just need – you need a little compassion when it’s delivered.

PAULA: I need compassion when it’s delivered, and I needed to be treated as if I was intelligent, as if I could handle this. Well, you do understand that with each recurrence that it might reduce your chances of survival.

Even the tone made a huge amount of difference. But I will never forget that line written across that piece of paper, as if each line was, like, you could feel years scratching away from my life, as if he was looking at me as if, you know, dismissive. I’m not going to spend much time with you because you’re terminal.

LUDDEN: Well, Paula, thank you so much for calling.

PAULA: You’re welcome.

LUDDEN: Dr. Jain, I mean, how – how do you deliver terrible news like that?

Dr. JAIN: A couple of thoughts on Paula’s situation. I think she’s making the right statement about, one, getting rid of a doctor who was unwilling to partner with her. I think she used that term very appropriately.

And we all need to think about that, that the whole idea is that we need to partner doctors and patients together to reach our goal, the goal of not just quantity of life, not just the length of life, but also the quality of life.

So that’s a critical element that she sort of brought out. And there’s a whole movement towards patient-centered care, which is talking about this idea, this idea of doctors and patients partnering. Even in the ICU, we’re beginning to see patients and families together talking about diagnosis.

Some of the new ICUs, new initiatives in the ICUs, relate to a family member being part of the team, as well as other family members and patients being part of hospital teams and coming about to new ideas and new ways of solving problems.

Source : NPR

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