Service of Compassion in Medical Care

September 23rd, 2010

Categories: Communications, Compassion, Courtesy, Education, Excuses, Government, Indifference, Manner of Speech, Medical Care, Quality, Tone of Voice, Training

doctorwhitecoat

Just how much empathy and compassion should a doctor feel and exhibit? I’m of two minds.

Dr. Sally Satel, who wrote “Physician, Humanize Thyself” in The Wall Street Journal, spoke of the White Coat Ceremony for medical students that she claimed Dr. Arnold P. Gold of the Columbia University College of Physicians and Surgeons popularized. The symbolism of the ceremony, according to the Columbia University chaplain, is for doctors to consider their coats “cloaks of compassion.” Medical schools all over the country now conduct these ceremonies.

And I’m all for it. Having witnessed a top-rated specialist [according to a yearly listing in New York Magazine] treat my husband, who was suffering and weak, with less compassion than a plumber would feel for a pipe, I question the man’s reason for becoming a doctor. We see misfits in all sorts of professions, which is no excuse, but this fellow was all sorts of things he didn’t have to be: Rude, offhanded and wrong to the extreme in his approach to a diagnosis. Turned out my husband did have something in this person’s specialty, generated by a nasty tick bite, causing two+ months high fever and eventually the inability to get out of bed. [Husband is fine now.] A person like this doctor wouldn’t understand the significance of this or any other kind of compassion-related ceremony.

wheelchair1On the other hand, when confronted with horrendous disfigurement and frailty or facing a tricky operation with scalpel in hand, a doctor whose empathy makes him fall apart isn’t of much help, either. Referring to “respectful attentiveness and a genuine commitment to a patient’s welfare” Dr. Satel wrote: “It happens not in the classroom, of course, but ideally on the wards and in clinics under the watchful mentorship of seasoned physicians.” Maybe the nasty doctor spent all his time in the classroom.

Dr. Satel points to government intrusion, at junctures in recent history, as the cause for lack of compassion. As doctors are increasingly robbed of options by insurance companies and/or time–because of paperwork required by government regulation in combination with the numbers of patients they must treat in order to meet budgets and satisfy what Medicare will pay for-they can’t squeeze in anything else, much less compassion. [Medicaid seems to have an unlimited bank account and my advice is if you get really sick, sell everything and go on Medicaid, but I digress].

jugglingSatel concludes: “Juggling the timeless injunction to all doctors-be a mensch-with concepts like ‘Medicare metrics’ and ‘standardization’ (the new watchwords in health reform) will make it even harder for the newly coated students to become the kind of doctors that they themselves would like to have. An induction ritual acknowledging as much wouldn’t hurt.”

Wouldn’t a compassionate person still be compassionate under any circumstances? Is it the patient’s fault that a doctor must see 30 patients in the time she/he used to see eight to 10 or that the doctor has a pound of paperwork to fill out after every visit?

What can the public do about changing this increasingly unreasonable turn of events?

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8 Responses to “Service of Compassion in Medical Care”

  1. Frank Paine Said:

    I guess I’m the source of the first comment. OK, here goes. Keep in mind that in this discussion, whenever I refer to doctors, I mean to include all medical practitioners, including nurses, technicians, secretaries, etc.: anybody who is at all involved in patient care.

    Compassion, in the sense that we’re talking about here, isn’t just a cloak (or white coat) that we put on when we work (or play, or whatever) but a state of mind. The state of mind is there all the time or absent all the time. I don’t think there’s a middle ground. Any doctor who has to deal face-to-face with patients really needs to have the compassionate state of mind, and if he or she doesn’t have it, should probably find another profession.

    Having said that, there are doctors who never really need to spend significant time face-to-face with patients. Think of Dr. House on the TV show–he actively avoids being face-to-face because he knows that he is not good at it. That’s a TV show, but in real life, there are doctors engaged in research, surgery, radiology, etc. who only rarely spend time face-to-face with patients. For these folks, compassion is not nearly as important. Professional caring (that is, caring about the quality of one’s work), is important.

    P.S. As a very old friend of your husband, I’m sure glad that he’s better. Was this recent, or some time ago?

  2. Mervyn Kaufman Said:

    Doctors who now seem to want to see a new patient every 20 minutes (or what—they’ll go broke?) have developed a kind of studied detachment. Without necessarily checking their watches, they not only make patients wait (often inordinately long) but also practically genuflect at whatever attention they get.

    I don’t think medical schools can make a dent; I think it’s up to patients to shore up their connections and, in effect, strive to cement relationships. I can’t envision a time when physicians will want to hug their patients, but they might be more willing to smile and be sympathetic if patients greet their appearance warmly rather than adversarially.

  3. Homer Byington Said:

    As the tick bite victim of the uncaring doctor, I’d like to throw in my two bits.

    The fault was as much mine as the doctor’s. No one in his right mind, having most of the symptoms that come with one variety of tick bite and having nearby a terrific, common sense, caring doctor, John Magaldi of Sharon, Ct., who knows as much about tick bites as anyone in the country, would have gone to a City doctor who has probably never seen a tick in his life despite what he claims his specialty to be!

    I did, was miserable, and someone paid an appalling $60,000 to keep me that way. I can hardly blame the man for my stupidity.

    On a more cheerful note, I have suffered for many years from an incurable disease which is not contagious but unpleasant, and if not cared for, can become serious. I liked very much the doctor I first went to back in the 1980s who accepted my insurance and was a most thoughtful and caring man.

    (We became friends and used to discuss at length what was then wrong with medicine in America and still is. His view was that no two doctors, hospitals, et cetera were equal and that anyone promising “best care” for everyone was a hypocrite, or worse, a liar. He believed that the best way to deliver medicine was the capitalist way. “He who pays, gets.” I saw him the other day. He is doing fine, no longer accepts insurance, and is getting rich doing expensive things that appeal to vain ladies.)

    Anyway, under his care, way back when, I became worse, and eventually he sent me to the man he called his “guru.” I met this new doctor at his office in a hospital at 8:00PM. (I later learned that he’d been working since 8:00 in the morning and had agreed to see me before going home as a favor to my doctor.) I’d been waiting to see him over an hour when I finally got in. He was brusk, told me to undress, then took a call from his literary agent with whom he discussed the marketing of his latest book for 10 minutes while I stood in front of him sick with pain, feverish and shivering with cold! I never wanted to see him again.

    The rest of the story: The guru put me in his hospital for two weeks. I got well, refused to become his patient, went back to my friend and got sick again. An altruist, he fired a sure “meal ticket” and ordered me to go back to the guru.

    I was angry and apprehensive when I saw him, but the guru immediately put me at ease, patiently explained to me what was wrong with me now, how he planned to fix it, and acted like he had all the time in the world, which he didn’t since there were 12 people waiting to see him in his waiting room. That was 15 years ago. I’ve been seeing him four times a year ever since and pay a pittance for the privilege. I’ve also learned that he is the most compassionate of men, a true saint who still acts like he has all the time in the world, and gives far more of himself than he ever gets back from his patients.

    The moral of the story: If you’ve got a doctor who doesn’t seem to care, just think of your worst day at the office and multiply your anguish by ten. Beset on one side by politicians who above all have to get themselves reelected, and on the other, by insurance companies who care only about making more money, it is almost impossible for any doctor to do his job properly, far less be nice to his patients. Despite all, most of them, like the guru, do truly believe in their Hippocratic Oath.

  4. Jeanne Byington Said:

    Frank:

    Good point–not every lawyer is great at addressing juries either and those who do the research and help select juries have their place. House the character is a hoot and the actor is great! The love-hate relationship he has with his staff who can’t believe how horrid he is to patients points to their compassion which can get them into trouble at times.

    To answer your question, my husband is fine now, though the specialist didn’t even warn him to check that one of the side effects of the disease, involving internal swelling, had gone away. He heard that from another doctor. He had this summer before last. It was scary.

    Merv,

    The best I can hope for is time for a quick giggle or story with a doctor. As I’ve written before, when our primary doctor retires, I will go nuts. His office staff is as friendly and funny as he is. It helps if you hate tests because you are a who-wants-to-know-type such as me.

    Homer,

    How can you blame yourself for going to the “wrong” doctor? When I am offered a piece of business that I can’t handle for obvious reasons–I know nothing about the subject and have zero contacts and it would take eons for me to get my arms around the whole thing–I decline. The fancy schmantsy doctor you went to, with his Park Avenue private offices, should have done the same if he had no time, didn’t like you etc. etc.

    The good part of your story was how caring the people at Lenox Hill Hospital were to you from the woman who cleaned the rooms and changed sheets to the nurses and maintenance workers who seeing us shivering in over-air conditioned hallways offered blankets warmed in a microwave.

  5. Lucrezia Said:

    The first thing the public can do regarding doctors, is to realize they are human beings, and that as such, they come in varying sizes and colors, just like everyone else.

    The second, is to recognize the fact that much of the impersonality one sees in them does not come from meaness of spirit, but rather the necessity to not become involved with patients. It is not too far fetched to suppose that the doctor who treats one “no better than a pipe” may be one who is terrified of his feelings and behaves in an unacceptable manner in order to hide them. To reduce this to a more personal level, if the doctor who treats me like a pipe succeeds in saving my life because of extraordinary medical talents, why complain?

    It might also be remembered that doctors are scientists, not known to be a breed given to patting people on the head. More often than not, treating them with respect and learning to ask the right questions, along with exhibiting a willingness to learn, my well open the door to positive relations between potentially warring factions.

  6. Jeanne Byington Said:

    Lucrezia,

    I saw the pipe-doctor in action. He was rude and disinterested.

    He wouldn’t listen–we suggested that my husband might have [what he ended up having] because a friend who lived 20 minutes south of us seemed to have had the same a year before, but his pride got in the way and it was weeks before the diagnosis was made and he didn’t have the interest to tell either of us. [Because he was so slow in diagnosis, Homer had heart complications that took months to get back to normal.]

    I had another doctor who was reserved to the point of shy. I thought he was wonderful and after a very long while, he and I shared a chuckle or two. A friend couldn’t stand him. That’s what makes horseracing.

    But Dr. Pipe was another story. You can sense it. You don’t need a warm and oozy person. Competent and sincere would be nice.

  7. JBS Said:

    Our internist is a gem, not much younger than we are, so we are afraid
    he will retire soon (he’s already not working on Mondays), but no
    matter how busy he is, he always takes time to chat, to find out how
    our lives our going, not just our health. He’s given us his direct
    dial number so that in a crisis we can get right to him, we do not
    need to go through his nurse, and he always manages to fit us in, no
    matter how busy his schedule.

    I know for a fact that the number of patients he is expected to see
    has jumped dramatically since we started seeing him about 10 years
    ago. He told us about it and said he didn’t think it made him a
    better doctor. He generally works until after 7 p.m. writing his
    reports, he’s mentioned that too.

    And what sympathy I got when I was pushed out of my job at 64, and the stories I heard from him then and since about how terrible this is to do to older people whose minds are
    working well and were putting in a full day (or more) of work. It’s obvious I’m not the only patient he knows that this has happened to. I’ll bet many of your readers can relate.

    At any rate, this convinces me that no matter how busy someone is; if
    they serve clients/customers/patients they can always find the time to
    be kind and compassionate. I wouldn’t go to any other type of doctor.
    In fact, I’ve refused to go back to doctors that aren’t understanding and compassionate

  8. Jeanne Byington Said:

    JBS,

    I’ve read studies that report that people tend to get better in certain environments and then these studies are debunked. But I think that it is widely reported that stress helps nobody’s health. If a doctor’s attitude adds to the general tension that exists around illness, it’s counterproductive.

    I’ve written in previous comments about people who have walked out on doctors even though they are being treated with potentially life-threatening illnesses such as cancer, because they can’t tolerate having to wait for hours for their appointments. If more people did that when they felt mistreated [don’t these doctors have phones and assistants to call and tell you that they are running late?], the so-called genius specialists with attitudes of any kind would have plenty of time to bone up on their people skills.

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