Terrible Bedside Manners

[ljbaron]

I have a question or an inquiry if you will,  but when did doctors beside manners become so poor? My girlfriend has been having some groin pain, inflammation of her lymph node (most likely an infection). 

 

She decided to go to a walk in clinic, the doctor (mid 40s) had terrible manners, stood over her when talking to her (looked down on her). Overall bad experience.

 

Second experience was at University Hospital Emergency in London. Young residency doctor, once again terrible bedside manners, questioned her as if she was incompetent of analyzing her own body, (she's a nursing student) he was speaking to other doctors about other patients while my girlfriend was in the same room. A major no-no. 

 

Our medical schools should be teaching that beside manners are #1 priority. It does not matter if your dog just died, your mothers sick, your girlfriend just dumped you. When you're in scrubs it is your job to perform the task at duty and to treat your patients with the utmost respect.

 

What is happening with our system? Do we not teach how to ethically perform adequate bedside manners in med school anymore?

 

It seems as though more and more med students are getting into medicine for the complete wrong reasons, (i.e. their parents wanted them there). Do yourself a favour and adequately evaluate why you want to be in med school, because if you cannot treat your patients with dignity and respect you should not be in medicine. Period. 

[GH0ST]

I have a question or an inquiry if you will,  but when did doctors beside manners become so poor? My girlfriend has been having some groin pain, inflammation of her lymph node (most likely an infection). 

 

She decided to go to a walk in clinic, the doctor (mid 40s) had terrible manners, stood over her when talking to her (looked down on her). Overall bad experience.

 

Second experience was at University Hospital Emergency in London. Young residency doctor, once again terrible bedside manners, questioned her as if she was incompetent of analyzing her own body, (she's a nursing student) he was speaking to other doctors about other patients while my girlfriend was in the same room. A major no-no. 

 

Our medical schools should be teaching that beside manners are #1 priority. It does not matter if your dog just died, your mothers sick, your girlfriend just dumped you. When you're in scrubs it is your job to perform the task at duty and to treat your patients with the utmost respect.

 

What is happening with our system? Do we not teach how to ethically perform adequate bedside manners in med school anymore?

 

It seems as though more and more med students are getting into medicine for the complete wrong reasons, (i.e. their parents wanted them there). Do yourself a favour and adequately evaluate why you want to be in med school, because if you cannot treat your patients with dignity and respect you should not be in medicine. Period. 

 

Teaching is one thing...... but you can't teach personality (as much as we'd like to). 

 

The schools do their part to try and guide us....... not everyone walks down that path. 

 

That said, it's also easier to remember a negative experience than a positive one... and we never really know what's going on in the doctor's day (post-call, personal problems/burdens)... doesn't excuse them from their actions but the reasons are understandable. 

 

From another point of view, many people are interested in their specialty not because of the patients but the cases ...... it takes the person (experiences, emotions, values, and everything in between) out of the condition they experience. If they feel it's mundane, some people show apathy in their actions no matter how hard they try to do their jobs. 

 

Try not to let some poor experiences ruin your perceptions though.... there are still many good doctors out there as well..... that said it does help to have people give you a reminder or a check on your thoughts/attitudes. I'm fortunate enough that my SO is supportive but also recognizes when I may have phrased/acted poorly or in a seemingly arrogant way. Sometimes you don't mean what you do and it's helpful to get that reminder to help keep you on track. 

 

Perhaps introspection is something that should be taught as well... who knows? 

 

On another note...... I would disagree saying that medical schools should prioritize bedside manners as #1 ... to be fair a doctor really has to know their chops and the school's first responsibility is to create a physician, not necessarily a nice one. I may be among the minority opinion but I don't mind having a physician with poor bedside manners if they can do their job well (in any specialty) but I can understand why people disagree. Does that mean I wouldn't appreciate good bedside manner? absolutely I would... 

 

- G 

[Talon01]

How did he question "her as if she was incompetent of analyzing her own body"? Can you elaborate?

[StriveP]

A lot of doctors are arrogant, not surprised. I'm sure there are lots of premeds on this forum who think the same way.

[robclem21]

Hi There,

 

I am sorry to hear that you have had several poor experiences with the healthcare system and that your girlfriend was not treated with the respect she deserves. I think it is important to keep in mind that no matter what field you go into, you will find people who don't necessarily do their job with the utmost care and compassion. However, I think you will still find that a very very strong majority of physicians are empathetic, compassionate, and do treat their patients with respect. You shouldn't generalize to an entire generation of doctors based on a couple bad experiences.

 

In regards to your comment about education, we do receive quite a fair bit of training on empathetic practice, as well as learning how to listen and communicate effectively with patients. As others have mentioned however, these softer skills are often more difficult to learn. I wouldn't blame the medical schools for the personalities of a select few who gain admission.

 

Lastly, and this is not to justify these actions by any means, but you should also consider the effect the system has on physicians, particularly in Canada. In addition to how physicians execute their role in healthcare, it can't go under-recognized that doctors are frequently overworked, exhausted, hungry, and operating under less than ideal circumstances. This is largely from unrealistic demand and considering we are similar to a lot of people with real life stress, occasionally there needs to be some reciprocal understanding of these circumstances from the public. Furthermore, I think the fact that people expect their physicians to completely disregard every aspect of their emotions, bury anything that happens outside the office, and shames them for showing any sort of discourse from being a brick wall is incredibly damaging to their mental health and performance. Two things that have been identified as issues in healthcare.

 

I agree there is the utmost need for professionalism at all times, and certain things are unacceptable.  There is and always will be room for improvement, but I think some recognition that doctors are prone to human experience is a healthy viewpoint for patients and for us.

[Hanmari]

I have a question or an inquiry if you will,  but when did doctors beside manners become so poor? My girlfriend has been having some groin pain, inflammation of her lymph node (most likely an infection). 

 

She decided to go to a walk in clinic, the doctor (mid 40s) had terrible manners, stood over her when talking to her (looked down on her). Overall bad experience.

 

Second experience was at University Hospital Emergency in London. Young residency doctor, once again terrible bedside manners, questioned her as if she was incompetent of analyzing her own body, (she's a nursing student) he was speaking to other doctors about other patients while my girlfriend was in the same room. A major no-no. 

 

Our medical schools should be teaching that beside manners are #1 priority. It does not matter if your dog just died, your mothers sick, your girlfriend just dumped you. When you're in scrubs it is your job to perform the task at duty and to treat your patients with the utmost respect.

 

What is happening with our system? Do we not teach how to ethically perform adequate bedside manners in med school anymore?

 

It seems as though more and more med students are getting into medicine for the complete wrong reasons, (i.e. their parents wanted them there). Do yourself a favour and adequately evaluate why you want to be in med school, because if you cannot treat your patients with dignity and respect you should not be in medicine. Period. 

 

If my mother was ill, you and your girlfriend probably would not even see me in hospital. That being said, I do aim to become a physician who knows when my quality of work is being affected by my personal circumstances. I agree that ideally neither should affect the other. As to whether I will realistically have the resources to remove myself from the workforce should I find myself in such a compromised situation, is another issue altogether.

[medway12]

I think it might be a hospital-related cultural thing. I've been to University Hospital at Western on two occasions and found the people there to be on the rude side. The first time, I asked the physician a simple questions about my injury and he gave me a reply but added " ...Science?" at the end, condescendingly implying that I have no idea what science is and that I should have been able to answer that question myself (somehow). The second time, the triage nurse was very unpleasant and clearly frustrated with her job. She talked in a way that made me feel guilty for being there because of my "minor issue".

 

But when I went for a visit over at Victoria Hospital, I noticed a completely different attitude and atmosphere. The doctor there was very kind and charming. The place itself was nice and modern - maybe that had to do with it. Another ER I've been to was Toronto General (UHN) and thought the nurses and the doctor there were respectful and professional.

 

So all in all, I think a hospital's overall top-down culture, politics, and poor operations/schedule management all can contribute to a bad culture and dissatisfied employees at some hospitals. University Hospital in my opinion, is just one of those places.

[rmorelan]

I think it might be a hospital-related cultural thing. I've been to University Hospital at Western on two occasions and found the people there to be on the rude side. The first time, I asked the physician a simple questions about my injury and he gave me a reply but added " ...Science?" at the end, condescendingly implying that I have no idea what science is and that I should have been able to answer that question myself (somehow). The second time, the triage nurse was very unpleasant and clearly frustrated with her job. She talked in a way that made me feel guilty for being there because of my "minor issue".

 

But when I went for a visit over at Victoria Hospital, I noticed a completely different attitude and atmosphere. The doctor there was very kind and charming. The place itself was nice and modern - maybe that had to do with it. Another ER I've been to was Toronto General (UHN) and thought the nurses and the doctor there were respectful and professional.

 

So all in all, I think a hospital's overall top-down culture, politics, and poor operations/schedule management all can contribute to a bad culture and dissatisfied employees at some hospitals. University Hospital in my opinion, is just one of those places.

 

What you are saying is interesting!

 

There is a lot of history between those two hospitals. Not sure how true this is but I was told when Victoria Hospital was built they recruited what they thought was the best doctors from the old university hospital to come our to their new and modern place etc, etc for most of the fields. At the time they were under completely different management. So imagine if you were one of the people not invited over, and what that meant your peers thought of you (or at least some of your peers).

 

Fast forward a number of years, where each group developed their own style and methods right down to the items on the surgical trays, had their own trainees taught their way, and their one internal deals and arrangements - systems that actually worked. Then they were effectively merged under one management - overnight - by the province. Now imagine those two groups having to work together after so many years, errr, not working together. I mean really not working together, ha. Imagine the politics if you can (and trust me it is hard because that is just how messy it was).

 

Now imagine the funding is reduced. Imagine you trained people that you wanted to hire in the end - almost promising them a job and now there isn't one. Imagine cuts in OR time etc, etc. Imagine meetings, more meetings, and even more meetings.

 

now you just may have had two bad days. Could easily be it. Still it is interesting (well interesting to me) to try to see how the system actually works (or doesn't, ha). It is a messy world out there

[rial2]

I think it might be a hospital-related cultural thing. I've been to University Hospital at Western on two occasions and found the people there to be on the rude side. The first time, I asked the physician a simple questions about my injury and he gave me a reply but added " ...Science?" at the end, condescendingly implying that I have no idea what science is and that I should have been able to answer that question myself (somehow). The second time, the triage nurse was very unpleasant and clearly frustrated with her job. She talked in a way that made me feel guilty for being there because of my "minor issue".

 

But when I went for a visit over at Victoria Hospital, I noticed a completely different attitude and atmosphere. The doctor there was very kind and charming. The place itself was nice and modern - maybe that had to do with it. Another ER I've been to was Toronto General (UHN) and thought the nurses and the doctor there were respectful and professional.

 

So all in all, I think a hospital's overall top-down culture, politics, and poor operations/schedule management all can contribute to a bad culture and dissatisfied employees at some hospitals. University Hospital in my opinion, is just one of those places.

 

I recently read a news article stating that UH is one of the most overcrowded hospitals in Ontario, it could be a problem specific to overworked doctors at that hospital. 

[Lactic Folly]

Just a side note that, if we're talking about ER, it's the same group of emergency room physicians that rotates through both of the above hospitals.

[Arztin]

Our medical schools should be teaching that beside manners are #1 priority. It does not matter if your dog just died, your mothers sick, your girlfriend just dumped you. When you're in scrubs it is your job to perform the task at duty and to treat your patients with the utmost respect.

 

What is happening with our system? Do we not teach how to ethically perform adequate bedside manners in med school anymore?

 

Hi,

I'm sorry you had a horrible experience. I don't know for Western specifically, but communication and empathy is heavily emphasized on pretty much in any school in North America. Therefore, it's probably not an education problem.

 

Now, in regard to your statement, you are right that as a patient, you shouldn't be treated like sh*t even if the doc is having a bad day. Unfortunately, MDs are just human beings and they have emotions too. Just think about that neurology R4 in Florida who got dumped by her long-term boyfriend. She got drunk, and hit an Uber driver. It's obviously not okay, but keep in mind that they're just regular human beings with emotions.

 

Now, regarding the answer to your question, it's a pretty complex issue and I don't know the problem fully. However, I do think there are some key elements such as: 

1- the fact that many residents/staff are often overworked (I've seen a resident work 21 days in a row - although he did switch some calls so that he can stack up a continuous 5 day break so he can go to his hometown. Also, in practice, clinics almost never finish on time because there are almost always too many patients in a given day for a clinic.)

2- burn out (I've seen a MD/PhD staff who was most obviously burned out. His typical day was: research lab, consults - if he was the specialist of his kind on call that day, supervising med students / residents, his own clinics. He was most obviously burnt out, and had poor manners)

3- cynicism (I've seen staff/residents talk behind the back of the patients the moment they leave. sneer, judging them etc...)

As a junior med student I've hard my share of these too. I mentally judged patients, e.g. one who was actively cheating on their partner by having unprotected sex. I had days where I felt truly tired. I've seen some clerks in distress/overwhelmed. During our 2 week surgery block in med 2, when I was doing clinics, I really can't say that my manners were always great neither. The dilemma often became: take 40-60 minutes with a patient , get the patient to think you're the most awesome health care worker ever and have the staff think you're super slow/incompetent, or take 20 minutes and get praise and a good evaluation from your staff, at the price of having the patient think you're totally rushed? In this kind of situation, it's truly hard to take the time and have the best manners and let patients talk in an uninterrupted fashion, which most of the time is totally inefficient.

 

But all in all, keep in mind that although it's absolutely true that you shouldn't be treated like crap, MDs are just flawed and regular human beings working in a flawed system.

[Wartortle]

I agree with Arztin.

 

I would also add another point. I think most students (i.e. high school/university) and possibly some M1/M2 students have an overly optimistic view about the field. Now once they are residents or practicing it isn't what they expected at all and now they are bummed out by their circumstance. 

 

I think this is a point that is often overlooked. I understand this is reduced by volunteering and shadowing (mostly in the States) but volunteering is very different from actually doing the work day in and day out. 

 

So imagine that you spend ~8 years (if everything falls in line, longer if they don't, even longer when including residency) working towards this profession. You get there and it just isn't everything you've heard of, seen, or been exposed to. This is usually worse for those who do it for the money and prestige of the profession.

 

The profession is a grind, both getting there and doing it.

 

Again, this is a complicated matter since it's human behaviour. That being said there are so many factors that affect how individuals behave, which I feel my point is one of them.

 

P.S. 

 

One of my acquaintances from school was complaining about medical school taking too long. They got accepted in Canada and hope them the best but I don't understand some individuals mentality regarding the profession. It takes long because the material is dense and patient well beings will eventually be in your hands. So...

[medway12]

What you are saying is interesting!

 

There is a lot of history between those two hospitals. Not sure how true this is but I was told when Victoria Hospital was built they recruited what they thought was the best doctors from the old university hospital to come our to their new and modern place etc, etc for most of the fields. At the time they were under completely different management. So imagine if you were one of the people not invited over, and what that meant your peers thought of you (or at least some of your peers).

 

Fast forward a number of years, where each group developed their own style and methods right down to the items on the surgical trays, had their own trainees taught their way, and their one internal deals and arrangements - systems that actually worked. Then they were effectively merged under one management - overnight - by the province. Now imagine those two groups having to work together after so many years, errr, not working together. I mean really not working together, ha. Imagine the politics if you can (and trust me it is hard because that is just how messy it was).

 

Now imagine the funding is reduced. Imagine you trained people that you wanted to hire in the end - almost promising them a job and now there isn't one. Imagine cuts in OR time etc, etc. Imagine meetings, more meetings, and even more meetings.

 

now you just may have had two bad days. Could easily be it. Still it is interesting (well interesting to me) to try to see how the system actually works (or doesn't, ha). It is a messy world out there

 

Agree. Healthcare politics is a bigger deal than most outsiders realize. In Canada, it may be even more political because it's government funded. Double trouble lol.

[ralk]

We don't emphasize good communication nearly enough in medical education. There is some training in medical education, but it's very cursory - I got better training in how to talk to patients before medical school than during. More importantly, it's not well reinforced after being initially taught in pre-clerkship. Egregious examples get corrected, but not much beyond that. Anyone passable continues to be passable, even if there is significant room for improvement in patient interactions. It doesn't help that many preceptors in medicine have less-than-stellar bedside manner themselves. Of course, preceptors would have to be present when their subordinates are interacting with patients to provide feedback on bedside manner and it's surprising how little that happens. The end result is that trainees with poor patient interactions often aren't even aware they're underperforming.

 

Communication should be a much higher priority in medical education, though it inevitably does have to take second fiddle to being medically competent. A good communicator who doesn't know the medicine is far more dangerous than a poor communicator who does know the medicine, even though poor communication is quite dangerous in its own right. Fortunately we don't have to choose one or the other - we can and should have people who are skilled in both domains.

 

I'll agree with my fellow posters that the pressure, fatigue, and lack of support that comes with medicine can make some physicians more irritable and less compassionate, but I don't feel that has any place in this conversation and I'd argue they shouldn't be mentioned at all, even with disclaimers. For one, all those elements can be addressed, so if we want to put the blame on these factors, we have to turn it on ourselves at least partially, since physicians could collectively be doing a lot more to improve these factors. More importantly, to the extent that these factors are fixed parts of medicine, any blowback on patients is a misdirection of negative emotions and still completely unacceptable. We wouldn't excuse a man who comes home stressed from work if he hit his wife or children, we shouldn't absolve physicians when they pass their frustrations onto patients (or trainees, another common occurrence). Medicine has been far too tolerant of bad behaviour by using stress as an excuse.

 

All this said, I think things are better than in the past. Newer physicians seem to have better bedside manner in general when compared to older generations, though there is a huge spectrum at all ages. There is an increased focus on communication, even if progress in that direction is unacceptably slow. We're nowhere near where we should be, but at least we're past the days where practitioners can routinely be abusive with impunity; the trend is in the right direction.

[Hanmari]

Unfortunately much of that pressure, fatigue and lack of support comes directly from and is caused by the patients themselves, who are antagonistic and entitled in ways that cannot be satisfied in a publicly run healthcare system. When a physician takes out his unrelated anger on a patient, that is a breach of professionalism as it would be in any other job. When it is a direct blowback to a patient who's causing it, however, that is a different issue; CanMEDS roles don't include coddling. Of course, proper communication in medicine entails thorough explaining to the patient about the limitations of the system and also those of the physician him or herself. A cursory dismissal of the patient's concerns remains unprofessional. However, if all that the physician receives from the other end is blame and ridicule after having explained the situation in detail, the physician cannot be expected to turn the other cheek. Physicians aren't religious figures. There is nothing special about medicine that gives its users some sort of moral carte blanche; it is an industry where goods are offered, purchased (albeit indirectly), and are provided. If the customer is always king, then the provider is always a slave; there is no place for that kind of culture in any profession.

 

I may have veered off the point of this thread, I apologize. The focus of this thread wasn't really that "bedside manners" don't equate to unconditional service. Certainly in the OP's examples, I would have agreed that there were aspects of unprofessional conduct...I just got a bit frustrated at the overall situation in healthcare, that is all.

[ralk]

Unfortunately much of that pressure, fatigue and lack of support comes directly from and is caused by the patients themselves, who are antagonistic and entitled in ways that cannot be satisfied in a publicly run healthcare system. When a physician takes out his unrelated anger on a patient, that is a breach of professionalism as it would be in any other job. When it is a direct blowback to a patient who's causing it, however, that is a different issue; CanMEDS roles don't include coddling. Of course, proper communication in medicine entails thorough explaining to the patient about the limitations of the system and also those of the physician him or herself. A cursory dismissal of the patient's concerns remains unprofessional. However, if all that the physician receives from the other end is blame and ridicule after having explained the situation in detail, the physician cannot be expected to turn the other cheek. Physicians aren't religious figures. There is nothing special about medicine that gives its users some sort of moral carte blanche; it is an industry where goods are offered, purchased (albeit indirectly), and are provided. If the customer is always king, then the provider is always a slave; there is no place for that kind of culture in any profession.

 

I may have veered off the point of this thread, I apologize. The focus of this thread wasn't really that "bedside manners" don't equate to abject service. Certainly in the OP's examples, I would have agreed that there were aspects of unprofessional conduct...I just got a bit frustrated at the overall situation in healthcare, that is all.

 

No, that's still a problem. Antagonistic and entitled patients are still patients. Often scared, confused, frustrated patients. Physicians throwing that frustration back at patients helps no one and blaming patients for a physician's bad behaviour is frankly unacceptable.

 

I'm not saying physicians should tolerate everything that gets thrown at them, far from it. Violent patients should be restrained, removed by security or detained by police as the situation warrants. Firm lines should be drawn with patients who are manipulative, exploitative, or abusive and it is completely reasonable for physicians to sever relationships with patients who are consistently acting inappropriately. However, refusing to tolerate poor behaviour from patients does not require any sort of aggressive, dismissive, or belittling behaviour on the part of physicians to accomplish. We don't have to treat patients like kings, but we do have to treat them like people - all of them.

[A-Stark]

No, that's still a problem. Antagonistic and entitled patients are still patients. Often scared, confused, frustrated patients. Physicians throwing that frustration back at patients helps no one and blaming patients for a physician's bad behaviour is frankly unacceptable.

 

I'm not saying physicians should tolerate everything that gets thrown at them, far from it. Violent patients should be restrained, removed by security or detained by police as the situation warrants. Firm lines should be drawn with patients who are manipulative, exploitative, or abusive and it is completely reasonable for physicians to sever relationships with patients who are consistently acting inappropriately. However, refusing to tolerate poor behaviour from patients does not require any sort of aggressive, dismissive, or belittling behaviour on the part of physicians to accomplish. We don't have to treat patients like kings, but we do have to treat them like people - all of them.

 

 

Sorry, why are you even bringing up violent patients in this thread? Violence from anyone in a workplace is extremely serious and if coming from patients they MUST be restrained and in most cases police MUST become involved. I have been attacked by a patient in the past - and it was one who was completely unknown to me. Quite frankly we put up with far too much shit from verbally abusive or simply disrespectful people in our profession. I disagree with the notion that two isolated examples from the OP can be generalized to some sort of problem with medical training. (And what is meant by "ethically... adequate bedside manners"?) 

[ralk]

 

 

Sorry, why are you even bringing up violent patients in this thread? Violence from anyone in a workplace is extremely serious and if coming from patients they MUST be restrained and in most cases police MUST become involved. I have been attacked by a patient in the past - and it was one who was completely unknown to me. Quite frankly we put up with far too much shit from verbally abusive or simply disrespectful people in our profession. I disagree with the notion that two isolated examples from the OP can be generalized to some sort of problem with medical training. (And what is meant by "ethically... adequate bedside manners"?) 

 

I was describing limits to what we should tolerate from patients - I don't think we're in disagreement that violence is not something we should be accepting from anyone and I brought it up only to preemptively emphasize that point.

 

I also agree that two isolated examples can't be generalized to a problem in medical training. However, we still have a problem with communication in medical training, irrespective of those examples. There is a bulk of literature indicating that poor physician communication leads to worse outcomes for patients. There is also a good amount of literature indicating that poor physician communication is not unavoidable and that some practitioners do much better than others.

 

I also fully agree that "we put up with far too much shit from verbally abusive or simply disrespectful people in our profession". I'm not advocating we put up with poor patient behaviour, I'm saying we shouldn't throw it back at them. Two wrongs don't make a right, and all those other lessons we were supposed to learn in Kindergarten. A verbally abusive or disrespectful patient can be managed to their benefit and to ours, without condoning their negative behaviour. I've seen physicians, residents, and other students diffuse these patients quite expertly. I've handled a few of these patients myself. With good communication skills, many of these patients don't have to be a big issue. When these patients get verbal abuse or disrespect back, however, it just escalates the situation.

 

That's partially why I see a much bigger problem with verbally abusive or disrespectful physicians. They're a small minority of doctors, but they cause a lot of problems and we let them continue largely unopposed. More importantly, just as inappropriate patient behaviour can push physicians to react poorly, inappropriate physician behaviour can easily elicit poor behaviour from patients. The difference in these situations is, of course, that physicians are professionals getting paid to do a job, the patients are typically sick, and there exists a significant power differential between the two in favour of the physician. That puts the onus on the physician to be the bigger person. Yeah, that sucks, that we always have to take the high road, but that's part of the job, and we're more effective at that job when we do take that high road.

[Hanmari]

There is a good reason why staff always tell us that as medical students, we have the most time to spend with patients and address their concerns; it's not just time, actually. The type of communication that defuses unreasonably negative patients takes not just time and physical resources but the emotional reserves of the physician, which is also a resource in and of itself. And as with any other resource, the patience of the physician is finite and is to be allocated justly amongst all patients. If a particular patient is taking away unreasonably from that reserve, then the physician has the right and responsibility to stop giving away candies. I agree that it does not help the situation to return verbal abuse; I admit I used the wrong words when I said "direct blowback" to patients. Such interactions should instead be cut off efficiently and without emotional escalation on part of the physician, to prevent the patient from draining the doctor any further. Not as ideal as being infinitely diplomatic with every patient, I agree. But in the face of limited personal reserve, ending the interaction quickly would be the higher road compared to returning abusiveness outright.

[ralk]

There is a good reason why staff always tell us that as medical students, we have the most time to spend with patients and address their concerns; it's not just time, actually. The type of communication that defuses unreasonably negative patients takes not just time and physical resources but the emotional reserves of the physician, which is also a resource in and of itself. And as with any other resource, the patience of the physician is finite and is to be allocated justly amongst all patients. If a particular patient is taking away unreasonably from that reserve, then the physician has the right and responsibility to stop giving away candies. I agree that it does not help the situation to return verbal abuse; I admit I used the wrong words when I said "direct blowback" to patients. Such interactions should instead be cut off efficiently and without emotional escalation on part of the physician, to prevent the patient from draining the doctor any further. Not as ideal as being infinitely diplomatic with every patient, I agree. But in the face of limited personal reserve, ending the interaction quickly would be the higher road compared to returning abusiveness outright.

 

I totally agree, physicians shouldn't be endlessly calming down unreasonable patients. That's draining and impossible for even the most ardent person to keep up.

 

However, if a physician is constantly having to calm patients down, they tend to already be demonstrating poor communication skills. I'll give an example - I had one preceptor who was fantastic about responding to patients' questions and concerns. He was incredibly thorough and would provide long explanations, with reassurance for any points of worry. Yet, whenever he met a patient, he'd almost always put his foot in his mouth within the first few minutes, causing a lot of his patients' confusion and worries. He was playing catch-up from the start, taking a lot more time - and undoubtedly more emotional energy - than he really needed to.

 

Good communication skills can be effective in most circumstances without having to take a lot of time or draw down emotional resources, especially for physicians who use strong communication skills proactively. This is a major gap I see in current medical education when it comes to communication training.