I’m often asked to do book reviews on my blog, and I rarely agree to them. This is because it takes me a long time to read a book – and then if I don’t enjoy it, I figure the author would rather me remain silent than publish my true thoughts. Most of the reviews that I end up writing are unsolicited, but today is an unusual exception. A colleague asked me to read her book, “How To Be A Rock Star Doctor.” I got half way through when she checked in to see how things were going. I had to tell her that I didn’t agree with some of her advice to young doctors, and I worried that she would be discouraged by my honesty.
I was very pleasantly surprised to find that she welcomed the criticism and actually asked me to write my review – favorable or unfavorable as I saw fit. She is the very first author to take that position (others have thanked me for not writing a review) and I am proud of her for it.
In essence, How To Be A Rock Star Doctor, is an easy-to-read primer for young primary care physicians looking to setup their first outpatient practice. The troubling part of the book (for me) was Dr. Bernard’s approach to the empathy fatigue that can set in for overworked physicians. In her view, we must “fake it” if we’ve lost it or don’t have it.
The book contains specific advice for how to appear empathic. Smiling broadly (no matter how one is feeling internally), dressing in a white coat, and exuding confidence, are recommended because we should see our patient interactions as an acting role – we are on stage, and they are depending on us to look/act the part.
Although Dr. Bernard rightly points out that there is research to support smiling as a means to achieving a happier mood, I was left with a certain uneasiness about the idea of putting on an act for patients. Something about the potential for dishonesty didn’t feel right to me. But then again, maybe the alternative – just being oneself – can create a poor therapeutic relationship if we’re in a bad mood for some reason.
I have heard many times that doctors can be uncaring to patients. Heck, I’ve even blogged about terrible interactions that I’ve had with my peers when I was in the patient role. But what is the solution? Should doctors learn how to imitate the qualities of a compassionate physician to achieve career success, or should we go a little deeper and actually try to be caring and let the behavior flow from a place of sincerity?
On the one hand, any tips to make the doctor-patient relationship go more smoothly should be welcomed… but on the other, if patient care is just an act, then what kind of meaning do our relationships have? If we act empathic do we eventually become empathic? Maybe yes, maybe no.
One thing I’m sure of, Dr. Bernard has opened an interesting discussion about how to handle stress, burnout, and create an excellent therapeutic experience in the midst of a broken healthcare system. She is willing to take criticism, and has endeared herself to me through our email exchanges. While I may not agree with all of her strategies to optimize patient satisfaction, one thing seems clear: she is as advertised — a rock star doctor.
Check out her book and find your own path forward.
Medical errors are estimated to be the third leading cause of death in America’s hospitals. Though some of these errors are beyond physician control, many are the direct result of physician action and inaction. I spend a lot of time thinking about how to reduce these errors and I (like many of my peers) lose sleep over the mistakes I witness.
When you ask patients what quality is most important in a physician, they often answer, “empathy.” I think that’s close, but not quite right. I know many “nice” and “supportive” doctors who have poor clinical judgment. When it comes to excellent care quality, one personality trait stands out to me – something that we don’t spend much time thinking about:
A physician with a curious mind doesn’t necessarily know all the answers. He may not be the “smartest” graduate of his medical school. But he is a great detective, and doesn’t rest until problems are solved. This particular quality isn’t nurtured in a system that rewards partial work ups, rapid patient turnover, and rushed documentation. But some doctors retain their intellectual curiosity about their patients – and to the extent that they do, I believe they can significantly reduce medical errors.
Many of the preventable adverse events I have witnessed (outside of procedure-based errors) began with warning signs that were ignored. Examples include abnormal lab tests that were not followed up in a timely manner, medication side effects that went unrecognized, copy errors in drug lists, and subtle changes in the physical exam that were presumed insignificant. All of these signs trigger the curious mind to seek out answers in time to head off problems before they evolve into real dangers.
Of course, there are other qualities that make a physician excellent – wisdom, experience, kindness, and a grounding in evidence-based practice come to mind. But without an engaged mind fueled by genuine curiosity, it’s hard to retain the vigilance required for continued good outcomes.
Curiosity may have killed a cat or two, but I’ve seen it save a large number of patients!
I am a regular reader of patient blogs, and I find myself frequently gasping at the mistreatment they experience at the hands of my peers. Yesterday I had the “pleasure” of being a patient myself, and found that my professional ties did not protect me from outrageously poor bedside manners. I suppose I’m writing this partly to vent, but also to remind healthcare professionals what not to do to patients waking up from anesthesia. I also think my experience may serve as a reminder that it’s ok to fire your doctor when conditions warrant.
I chose my gastroenterologist based on his credentials and the quality of training and experience listed on Healthgrades.com I had no personal recommendations to rely upon – so I used what I thought was a reasonable method for finding a good local doctor. When I met him for our initial office consultation he seemed rushed and distracted, without genuine curiosity about my complaints, complicated history, or how to help me find the correct diagnosis. I brushed my instincts aside, presuming he was just having a “bad day” and hoping for more time to discuss things fully once a battery of blood tests had been completed.
Sadly, I didn’t have the chance to review the results with him – instead he instructed his nurse to read me the results over the phone and to schedule me for a colonoscopy. I wanted to discuss the pros and cons of the procedure and what he thought he might be able to rule out with the test. He did not provide me with basic informed consent information, nor was he able to articulate medical necessity for the scope. I decided not to have the test, and I didn’t hear another word from him or his office.
Months later my symptoms had worsened and so I decided that a colonoscopy might help to further elucidate the potential cause. I was not able to get through to my doctor via phone, so I scheduled the test via his nursing staff. I planned to be the first patient of the day, so that we would have time to discuss my symptoms and concerns.
On the day of the procedure my physician stormed into my surgical bay and began reading my medical history to me from the computer screen, without exchanging basic niceties or introducing himself to my husband. I confirmed the information and tried to offer some nuance since our last office meeting. He cut me off, and made me feel as if my observations were completely unhelpful and were getting in the way of our scope time. He left in a rush before I felt that he had any clear sense of what we were trying to accomplish or rule out with the procedure.
A jovial anesthesiologist then entered my curtained cubicle, and made genuine human contact with me. He inquired about the reasons for the procedure and expressed appropriate glee regarding my Mallampati grade I airway. I asked him if he would be so kind as to not position me directly on my left shoulder during the procedure as it was exquisitely tender from a recent orthopedic injury. He promised to do his best to protect the injury while I was sedated.
Cut to the endoscopy suite where the gastroenterologist enters with a grumble as the techs bustle around the scope equipment and the anesthesiologist explains the slightly altered positioning for my comfort. As the propofol anesthetic goes into my vein I feel the gastroenterologist push me fully onto my injury as I lose the ability to protest.
After the procedure I’m back in my bay with my husband, groggy but with more pain in my shoulder than anywhere else. The curtain is drawn back with a yank and in marches the GI doc, relaying the unanticipated abnormal findings. I ask (in a slightly slurred tone) for more information, to which he responds in a loud voice, “You’re not going to remember any of this so just be quiet and listen!”
I persist in my attempts to understand the details to which he shouts “Shut up and listen” with increasing decibels. When I say that the findings still don’t explain my symptoms and that I remain perplexed he says that I should “try probiotics.” Finally he leaves the room, not offering any reassurance about the possibility of bowel perforation and stating that we’ll “Just have to wait for the pathology report, and it will take a while because of the July 4th weekend.”
I was dumbfounded, and not just because of my post-anesthetic stupor, but because of the open hostility showed to me by one of my peers. I asked my husband if I was out of line in my questioning and he said that I sounded “like a drunk person” but that the doctor was definitely being “an a**hole.”
As the nurses untangled me from the IV and EKG stickers and rushed me into a wheelchair and out to my husband’s waiting vehicle, all I could say was “Wow, my gastroenterologist was really mean to me.”
The nurses just nodded and suggested that I wasn’t the first to notice that.
As I recover from the whirlwind interaction with the healthcare system, I feel relief and anger. I’m relieved that my GI doc didn’t perforate my bowel and that we accidentally caught some very bad stuff early on, but I’m angry about how I was treated and feel no closer to an explanation for my symptoms than when I started investigating a year ago. My experience was probably fairly typical for many patients dealing with physicians who have lost empathy and compassion. I am sad that there are so many like that out there and I promise to do my best not to follow suit.
My bottom line on gastroenterologists (sorry for the horrible pun): Go with your gut. If your doctor displays jerk-like tendencies during your office visit, rest assured that they can bloom in time. Have the courage to find another doctor before you put your life in their hands and/or they get the chance to verbally abuse you in a post-anesthetic stupor. I am firing my doctor a little bit on the late side, but doing it nonetheless. I just hope that my orthopedist is a good egg (like my anesthesiologist) – because I’ve got one heck of a sore shoulder coming his way!
How much are good bedside manners worth? Would you double your copay if you could be guaranteed an extra measure of TLC from your physician? Can we put price on a physician’s warm smile, an understanding nod or a reassuring hand on your shoulder? Do patients have to contract with a concierge medical practice to receive this treatment?
I agree that our bedside manners with patients need some rejuvenation. It’s not fair, however, to isolate this issue out of context. Physicians today are facing crunching pressures from various sources that we cannot always compartmentalize when we are facing our patients – even though we should. Most folks believe that the bedside manners of the prior generation of physicians were superior to ours. Were our predecessors simply more compassionate and caring human beings than we are? I don’t think so. I think the medical profession was a different beast then. I hypothesize that if these wizened physicians entered the profession today, that they would behave differently.
Context is so critical when examining any issue. Read more »
*This blog post was originally published at MD Whistleblower*
It seems that there are medical schools taking the initiative to help their students become more compassionate. It’s a worthy goal but I don’t know if it’s possible. We can teach individuals to act compassionate. But that, of course, is different from being compassionate. While there may be literature to support the cause, I don’t think that a curriculum can cultivate empathy.
Is it possible to change a student or doctor’s heart? Of course, I see it all the time. But not from role playing or small groups. It’s human circumstances that drive change. Personal loss and life experience tempered by introspection and humility change how we see those around us. It’s only when we recognize our own vulnerability that we can begin to see it in others. This doesn’t happen in a classroom. Read more »
*This blog post was originally published at 33 Charts*