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Can you rephrase that, doc?

True, they haven't been to a finishing school. But only some docs know how to communicate bad news to patients

Eighty-year-old Hymavathi was furious as she came out of the consulting room. Her complaint: "The doctor examined me and said, `Why should you worry about it at your age?' If she didn't want to treat me, she should have kept quiet. I'm not coming here again."

A woman waiting to go in shook her head. "My dentist is a hi-tech sphinx. Throughout the procedure, he never asked questions, never wanted to know how I felt. Sure, I couldn't speak most of the time, but he didn't have to be so clinical!"

If that gives you the heebie-jeebies, listen to Ram. "My routine treadmill result came out marginally (askew). Instead of telling me not to worry about a minor problem, the cardio said, `Two years since bypass, and this!' His tone almost killed me on the spot. I thought my days were numbered. He then said my cholesterol was fine and I could eat what I wanted. Did he mean it? When I left, I was sure of only one thing. No visiting this guy again!"

Vocal therapy

Pleasant behaviour is a must for a doctor, said Ram, who now takes his troubles to a likeable young GP. "The diagnosis may be okay, but if the doctor isn't able to boost the patient's confidence, anxiety will make him worse."

Sankaran, a retired bank employee, went nostalgic: "Our family physician would give us a bottle of liquid, smile and pat us. Why do I remember him as a favourite uncle?"

This is not to say doctors en masse are rude. It means that patients value good bedside manners. They want doctors to know what to do medically. But they also expect to see a face that is kind, hear words that sound gentle, certainly from those to whom they bare their body and spill their guts. Also, if they don't like the doctor, they are probably not going to follow his or her advice. If parents don't feel comfortable asking questions, they may not know enough to care for their sick child. Isn't it in the interest of doctors to make sure of patient satisfaction?

Make a dipstick survey. You'll find that respondents prefer meds who listen to their concerns, who are not sarcastic, and who don't pass judgments on their habits. They prefer a friendly voice to the purr of a cutting-edge, state-of-the-art machine. Chances are an understanding nod has a better impact than the PowerPoint presentation disseminating the latest medical research. Any medical journal will tell you: physician, be more personable.

The consultant today is generally as caring and compassionate as his clan in the 1950s. So his brusque, business-like behaviour may be because of outside factors. Maybe there is more pressure to see more patients. There are more tests, more reports, more scans, more results. Maybe job-hopping, insurance plans and super-speciality medicine ensure that the patients aren't seeing the same doctor all their lives. The doctor knows too little about the patient's background to have effective patient-physician communication.

The long-suffering Ram warned of the flip side to this therapeutic coin. "There are medicos who make deep incisions in your financial health with smooth talk and a sweet smile."

"The first impression of a doctor is extremely important for a patient," said Bharathi, who has seen her family through major medical crises. "Sometimes the medication isn't all that effective, but I don't mind going back if I find him tolerant. An ENT specialist told us: `If you want to get well, your tonsils must be scraped off.' The kid and I thought he was positively scary."

"Cardios, cancer surgeons and fertility docs have to break news in black-and-white, but can't they sugar-coat it a bit? `Cancel your holiday!' v/s `You may have to postpone it, is that okay?' Can't they be sensitive and give us some reassurance? The `no' at the fertility clinic can come politely. I think it's a personality trait. Some know how to communicate bad news, others don't. They must be trained to be courteous."

Most doctors learn it by trial and error, said a parent. They are cold and dismissive, say all the wrong things (`You won't understand!') till they discover the right ones, leaving a trail of despondent patients.

Admitted a paediatrician: "As is true of people in general, we often don't know what to say.''

Cutting-edge knowledge and kind words. One is of no good without the other, according to Priya Subramanian, doctor. She recommended teaching communication skills in medical schools. She invests a minimum of 20-30 minutes with each patient.

But her compatriot, Rajkumar, took a different stance: "We surgeons are technicians. I can't say, `Hello, Mrs. Jones, how are you?' in a sugary voice and treat her wrongly. Yeah, 80 per cent of the patients come here with urinary/chest problems or fever. These don't need hi-tech care or a signature above the small print. Sure, it helps if the doctor treats them to a smile. Empathising is a subtle game we play. But a doctor should want to heal! I do complex bariatric surgery where every stitch is a work of art. It's important I have the latest workshop and the best equipment. If I don't, I'll be carrying a wreath at the end of the relationship."

GEETA PADMANABHAN

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