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The art of remedy

Some doctors know how to communicate bad news, others don't

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." If that gives you heartburn, listen to Ram. "My routine treadmill result came out marginally positive. 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 anymore."

Pleasant behaviour is a must for a doctor, said Ram, who now takes his troubles to a likeable young GP.

Gentle words

This is not to say medicos en masse are rude. It means that patients, in their wisdom, 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 advice. If parents don't feel comfortable asking questions, they may not know enough to care for their child. Isn't it in the interest of doctors to make sure of patient satisfaction?

Chances are, an understanding nod has a better impact than 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. May be there is more pressure to see more patients. There are more tests, more reports, more scans, more results. May be job-hopping, insurance plans and super speciality medicine ensure that the patients aren't seeing the same medico all their lives. The doctor knows too little about the patient's background to have effective patient-physician communication. Ram warns of the flip side to this therapeutic coin. "There are those medicos who make deep incisions in your financial health with smooth talk and a sweet smile."

"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! vs. You may have to postpone it, is that ok?) Can't they be sensitive and give us some reassurance? The "no" at the fertility clinic can come politely, nicely? I think it's a personality trait. Some know how to communicate bad news, others don't. Can't they 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 unhappy patients.

Cutting-edge knowledge and kind words, one is of no good without the other, says Dr. Priya Subramanian. "One would never go to a healthcare organisation which embodied the kindest medical practitioners who took forever to finish medical school."

Yet, she recommends teaching communication skills in medical schools. "I think personal skills have been getting increasingly good , but on a relative scale it is still miniscule." She invests a minimum of 20-30 minutes with each patient.

Dr. Rajkumar of Lifeline group of hospitals hoists a broadside in defence of his tribe.

"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 high-tech care or a signature above the small print. Sure, it helps if the doctor treats them to a smile. 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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