We’ve got to stop calling doctor-patient communication “bedside manner”

We’ve got to stop calling doctor-patient communication “bedside manner”
"Doctors with patient, 1999." Seattle Municipal Archives. Used with permission of a Creative Commons License, which you can find here

To my ears, “bedside manner” sounds patronizing. It involves a kindly, elderly doctor sitting at your bedside, holding your hand and telling you everything’s going to be fine in a soothing voice. Marcus Welby, M.D. comes to mind.

When I hear people say that a doctor doesn’t have a good bedside manner, I wonder what they mean. Do they mean that she isn’t warm and nurturing? Does it mean he doesn’t listen? Does it mean they aren’t charming? Or, maybe it means that they don’t communicate well.

If it’s the latter, then I think folks should consider finding a new doctor because doctor-patient communication is critical to good health.

I’ve read several pieces about choosing a doctor, and people often focus on “skill.” When I chose an orthopedic surgeon to do my ACL surgery, for instance, I looked for someone who specialized in this specific surgery. I wanted a skilled craftsman with lots of experience.

As I got to know this surgeon, however, I realized I needed more than surgical skill. I also needed someone who would listen to my questions, provide clear answers, and take the time to help me understand my procedure.

My doctor did these things adequately. His greatest asset, however, was that he worked with a Physician’s Assistant who was much more engaging and forthcoming.

My surgeon is one of the moodiest doctors I’ve ever had and one of the most pessimistic. He basically told me that ACL replacement would likely make my arthritis worse, that it would increase my pain, and that I’d never be able to run again. He seemed determined to lower my expectations, and he was successful.

One day as I was waiting to see him, I could hear him talking to an elderly woman next door. Actually, I could hear him quarreling with her. She sounded like a pain in the ass, to be truthful, but I was surprised to hear him raising his voice and becoming audibly cross. I dreaded seeing him because I knew he’d be in a terrible mood. He was, indeed.

I got about five minutes of his time and was told, in his cross, hard-done-by voice that I should have stopped physical therapy weeks ago. I was good to go.

I would have preferred encouragement, maybe even some praise for my hard work. I would have liked him to ask how I was doing and whether I had questions. He couldn’t have given two cents about how I was doing because his surgical role in my life was done. I was a successfully repaired knee.

That’s fine, as far as it goes. The surgery was successful, his team was well equipped to help me out, and my physical therapist was great. However, if something had gone wrong, this moodiness and lack of curiosity about my overall health would have been more problematic.

The ability to communicate with patients is critical to their health. I was supposed to give myself some sort of shot after my surgery related to preventing infection, I think. I never understood what I was supposed to do, and I never did it. I was at home, swimming on pain meds with my knee in a bendy machine. I realized some months later when I was sorting through paperwork that I’d not done this step . I give my surgeon a good helping of blame for that.

African Americans and women suffer a worse prognosis after they’re diagnosed with bladder cancer. There are many reasons, which I’ve discussed here and here. Among other concerns, African Americans and women are less likely to opt for radical cystectomy, which is removal of the bladder. 

Even at stage one, a high grade bladder cancer can require this surgery, depending on circumstances. It is always recommended at stage two and above. Chances for survival without radical cystectomy at this stage are dim.

My suspicion is that a breakdown of doctor-patient communication contributes to this discrepancy between white male patients and African American and female patients. In order to make this choice, a person needs a strong argument from a persuasive doctor. Both parties need to be able to communicate, ask questions, listen, probe.

The more interesting question is, perhaps, why communication breaks down between African American and female patients and their docs. It’s a question that needs research.

If my young turk, hotshot orthopedic surgeon is the poster boy for someone who needs a workshop in communication, then my young turk urologist is the one who should give the training.

He’s not perfect, but he is close. He makes room for conversation during my checkups. While he busily types information into his computer at some points, he also sits and puts aside the computer to talk to me. He is patient, answering every question, explaining and translating research that I’ve brought him.

It helps that he’s funny and caring, but it isn’t necessary. I know I can talk to him, that he’ll be available to me if I need to call him later, which I almost never do. Reaching out to doctors is hard for me. Usually by the time I make a call, I’m so worried that I’m sick to my stomach. My doctor is adamant that I need to call before that point.

At one exam, he asked me how I’d been doing and I said that a month prior I thought I had a UTI. He looked me in the eye and said, “What did I tell you when you called to let me know?” Communication goes both ways, you see. He can’t provide good care if I’m not engaged in the process.

Patients have more knowledge about their own bodies than a doctor could ever discover through tests and procedures. We are part of the equation. Without our help, our willingness to speak and, then, to listen, we are unlikely to get quality care.

When communication is working, both parties are well informed and trust develops. Medicine is an art that demands understanding between doctors and patients. I don’t need someone to hold my hand or to tell me that everything is going to be fine. I need someone who listens, explains, and creates space for conversation. We all do.

Do me a favor? Click my “like” button and join our Facebook community.

If you’d like to know first-hand when I have a new post, type your email address in the box and click the “create subscription” button. My list is completely spam free, and you can opt out at any time.

Filed under: Cancer, Doctors, Uncategorized

Leave a comment