Politeness and compassion matter

Its not your imagination but people these days I think are ruder in general than in the past. You heard about the rant by the woman her husband put on Youtube.... Or the trolls on Facebook who snipe at innocent people. Never mind the people who cut you off in traffic or exhibit road rage to a life threatening degree. Manners including please and thank you seem to have gone by the wayside. Thank you notes? What are those? Compassion? What's that? Privacy boundaries are gone as well. But do not let me get too far off track.

But its not just the general public. The newer doctors are exhibiting lack of politeness and compassion compared with more established doctors. Maybe they will acquire some politeness and compassion over time but int he meantime the patients suffer.

A study at Johns Hopkins showed that the newer interns didn't take time to introduce themselves to the patients or to sit and have an eye to eye conversation with them. The problem is that good bedside manner on the part of the doctor improves patient outcomes.

"The observers recorded whether the interns used five valued communication skills like introducing themselves, explaining their role to the patient, touching the patient, asking open-ended questions like, "How are you feeling today?," and sitting down with the patient for a conversation.

In some areas, interns scored high. For instance, they touched their patients 65% of the time (though that was sometimes in the process of giving physical exams) and asked open-ended questions 75% of the time during hospital visits. But interns only introduced themselves 40% of the time and explained their medical role 37% of the time. The interns sat down with their patients only 9% of the time.

In total, interns only performed all five behaviors during just 4% of their visits."

This week I went to a doctor appointment with my father. The doctor was running late and he stopped by the room where we were sitting to tell us he was coming but was running late. (Points for him). He introduced himself to me (more points) and greeted my father very nicely. He sat down and answered questions. He also asked open ended questions and was extremely patient with my father's questions even sketching diagrams. 

We left the appointment with a good deal of comfort in that he was the right doctor and would offer the right treatment.If the doctor had been abrupt and not communicative, we probably would not have the good feelings. Politeness and compassion do matter.

The impact of the decision.

The doctor makes a decision but do they stop and think about the impact? We hope so. But not always.

Here's the story of a 51 year old man who was admitted to the ER with liver and kidney problems. He needed to be stabilized before they could do necessary surgery. Stabilizing was not easy and not even sure that it could be done. He was in intensive care. Two internists stopped by to see him and in less than ten minutes decided what he needed was comfort care and not intensive care. So they moved him out of the ICU and into a regular ward where he died the next day.

What went wrong? Several things but the main one was the decision by the two internists to move him to a general ward for comfort care. A patient with multiple organ failure needs ICU if they are expected to survive. But to the younger interns, perhaps he was an older patient where he was ready for the end of life? But if he had been young, would more effort been made?

Also, was he a terminal patient? Or did he have a terminal disease? Could he have survived with the proper care?

The author concludes with:

"Perhaps what bothers me most is less the fate of our patient than the memory of those two doctors, both so young, efficiently dispatching a complicated decision in a matter of minutes, then dancing off without looking back. They knew a lot about the cost-effective deployment of intensive care. It would have been good to see them spend a little time struggling with the limitations of their analysis."

This is what bothers me - are we raising a new generation of doctors who don't think about the impact of their decision?