Twice in the last few months I have encountered grief as rage. Both were in the setting of the cardiac arrest of individuals who were already very ill. One was aged, with severe, end-stage heart disease. One was of middle age, but with metastatic cancer and on hospice.
In one instance, family members became angry because we did not leave the body in the ER for eight hours so that everyone could come and pay their respects. (Which I always thought was the purpose of a funeral home.)
In another, a family was angry because we did not allow everyone back into the room during the resuscitation of their cancer-stricken loved one — a resuscitation the family insisted upon, and which required rescinding hospice status. From observing their demeanor, their presence would have caused total chaos. Read more »
*This blog post was originally published at edwinleap.com*
Thanks to KevinMD for pointing out a recent NYT article about “etiquette-based medicine.” The author, a psychiatrist, suggests that physicians should use a check list to ensure courteous behavior and that this sort of thing should be taught in medical school. His suggestions were also published in the New England Journal of Medicine:
• Ask permission to enter the room; wait for an answer.
• Introduce yourself; show your ID badge.
• Shake hands.
• Sit down. Smile if appropriate.
• Explain your role on the health care team.
• Ask how the patient feels about being in the hospital.
If this sort of thing isn’t intuitively obvious to a physician then I’d say the blame should rest with his parents not his medical school. I mean, do we really need to teach doctors to knock on doors and smile on cue? Aren’t those sorts of things taught in pre-school?
It grieves me that some of my peers do not display what some might call “normal behavior” when interacting with patients. But I don’t think that’s related to their medical school curriculae – it’s the sad result of a broken healthcare system that wears thin our common human decency. Doctors are exhausted by clinical volume, henpecked by bureaucracy, delirious from lack of sleep, and stressed out by the daily grind of bad news, disease progression, and death. When well-groomed adults of sound mind require a checklist in order to smile appropriately, you know something’s terribly wrong.
Now, I don’t excuse disrespectful behavior – we docs must rise above our natural urge to be irritable at times, and remember that our patients are vulnerable and need our help. But for heaven’s sake… let’s drop the smug check lists and finger pointing. We’re all in this together, and it ain’t pretty.