Stone Soup: Doctor-Patient Communication

I was assessing an older patient who was in the last stages of dementia and was in the hospital recovering from pneumonia. She was unable to speak but each time I touched her she moaned in pain. Looking over her medications I decided that I would ask the doctor to increase her pain medications.

Dr. X was on the floor as luck would have it, surrounded by a gaggle of first year residents. He strutted into the patient’s room and his flock of med students surrounded the bed. I watched as he performed the most unprofessional assessment I’ve ever seen. He attempted to speak to this poor woman to ask her if she was in pain and when she didn’t answer he leaned over her and announced, “Well guys, you know my motto, the one who dies with the least amount of tubes wins!” He slapped his hand against her thigh briskly, making her moan again, informed me that he didn’t think she needed a boost in her dose, and then left the room laughing.

Now nurses aren’t stupid, and we are nothing if not advocates for our patients. I went over his head, reported his behavior, and got the patient the medication she needed.

After seeing this disgusting display of physician theater I kept asking myself, “What do these doctors really learn in medical school?”

To answer that I recently met and interviewed Mr. John McPhail, a Licensed Professional Counselor and Board Certified Medical Psychotherapist. He has a Masters Degree in Rehabilitation and Counseling as well as a Bachelors Degree in physiology, psychology and sociology. He is preceptor for a small group that is part of a class for all incoming first year medical students at the College of Osteopathic Medicine at Michigan State University called Doctor Patient Relationship.

During the first class of the semester McPhail asks his students to remember a time when they experienced some significant interaction with a doctor, and then he asks them to reflect on what made that experience meaningful or difficult. He suggests that as they begin to interact more with patients they observe more experienced physicians whom they admire, and take note of what makes them effective.

McPhail said that experienced doctors are often rushed for time, but they are skilled at the “art of medicine” and are adept at the little things that make a patient feel cared for.

I asked Mr. McPhail what he thinks is the most important thing a doctor should remember when breaking bad news to patients. He said that it’s spending time with them, sitting at eye level, saying statements such as “I wish I had better news” or “I’m really sorry to have to tell you this”. It’s vitally important that the doctor emphasize that he or she will do everything in their power to keep the patient comfortable.

Encouraging patients to have someone with them when they come to an appointment in order to have support is a good tip, and making a follow up appointment in order to ask questions later is important, as people are often numb when they hear unexpectedly bad news he said.

McPhail also suggests that his students read “Tuesdays with Morrie” by Mitch Albom.

It’s good to know that physicians are being trained in the fine art of communication because there are few experiences as vulnerable as waiting for news of a test or a biopsy.

I observed another doctor in a very different circumstance whose kindness and willingness to stay in the moment made all the difference in a very sad situation.

Four years ago my sister-in-law was at the end of a five-month run of treatment for ovarian cancer. Weakened and sedated for pain control she lay motionless in the bed. When the doctor entered the hospital room to speak to my brother Ken, I stood beside him for support.

Gently my brother was informed that his wife’s condition had worsened, and that there were no more treatment options left except for comfort care. “I’m so sorry,” the doctor said softly. My brother, unable to take it in, blinked a couple of times and said, “So, what are you going to do now, another round of chemo?”

The doctor, who clearly had given this terrible news many times, just gently repeated the news again. The heartache hung in the air like fog as my brother tried to gather his thoughts and process this unthinkable option. The oncologist didn’t fidget, didn’t look at his watch, he very skillfully just waited, focusing on my brother with a look of compassion.

I spoke next. “Are you trying to tell us, doctor, that there are no more treatment options and that we are going to focus on keeping her comfortable now?” He nodded, watching Ken to gauge his ability to absorb the news.

My brother, now tearfully grasping the situation, said, “Nothing? There’s nothing more you can do?” to which the doctor gently repeated his initial statement.

This ballet of sorts, this dance of information, was so delicate and intimate and was so very gentle that I felt a debt of gratitude to this doctor who stayed present with the pain that filled that tiny room. He stayed awhile longer as Ken expressed his grief at this news, listening and affirming Ken’s feelings, then as he left he told us to have him paged if we had any further questions.

This was a man who was in the sweet spot of his career. He didn’t have good news, but he broke the bad news in such a kind way that it softened the blow. If he’d been a batter, that conversation would have been a home run clear out of the park.

The truth is, is doesn’t matter if you’re a doctor or a telephone lineman, if you have ten years of higher education or none- there are jerks and there are gems.

As consumers we would be wise to assess a doctor’s ability to communicate, as well as his medical expertise, because if the time comes when he has nothing medical to offer, all you’ll be left with is his ability to communicate with you.

Doctor-patient communication