When the young Chinese doctor entered the room where I was, perched on an examination table, enveloped in a pink cotton gown, he seemed more nervous than me. I had recently been diagnosed with breast cancer and was seeking a consult with the surgeon who ended up excising the tumour.
As it happens with most doctors and surgeons of experience and renown, they are surrounded by fellows – apprentices really – training to become surgeons or specialists themselves. I had been told by the nurse who first examined me that the Chinese doctor would see me before the surgeon. Now he was standing there, somewhat unable to meet my gaze, and asking me inane questions such as “What worries you?” Are you fucking kidding me?? He examined me with heavy hands, nearly hurting me. But I didn’t say anything. He vanished, my surgeon stepped in and I was charmed by her wonderful ways and straightforward but kind manners. Years of practice, no doubt, but also a matter of her personality.
I never said anything to her about her fellow. I was too busy managing my disease. But I should have. If the object of the exercise was for the doctor to review my case and learn, I suppose he should have also learnt how to deal with the patient herself.
Nor did I say anything the time I went to see a periodontist, who came highly recommended, and who tried to gouge me for a set of X-rays I knew full well my dentist had already provided him with. I simply stood up and left.
For too long, people have revered doctors and their knowledge, hardly ever questioning their decisions, recommendations or bedside manners. But doctors are flawed humans just like the rest of us and their biggest challenge is often being able to involve a patient in the decision-making process or emotionally deal with him.
Delivering difficult news or complex information in a clear, concise manner while imbuing it with empathy is not easy. Some are better than others. And it’s an art that is hard to teach. Add to that the need to create a layer of distance for a physician to be able to function, day in and day out, without falling prey to depression or getting too involved (the medical profession has one of the highest incidence of suicide) and some doctors can come across as positively cold-hearted.
In their defense, the business of keeping people healthy can be an emotional minefield. I have witnessed first hand the expression of dismay, sadness and exhaustion right after a patient died, when I walked into the hospital’s cath lab on an errand, right when the team of doctors were discarding their gowns, silent, unable to even talk to each other. It doesn’t even come close to a bad day at the office, with a cranky boss.
Still, I have also witnessed a young doctor delivering the news of the death of a wife, mother, sister to her large family, while gingerly sitting on a desk, outside a bank of elevators, in plain earshot of anyone else, i.e. me, waiting for an elevator. I shouldn’t have been able to listen in; the child who threw herself on the floor, wailing, didn’t need my averting gaze. When I returned, a few minutes later, a priest and a grief counsellor had the situation under control but I kept on thinking the doctor should have thought of corralling the family to a more private setting.
But how on earth are they going to learn if we, the patients, don’t take the time to let them know about an interaction that did or did not work? Since my whole cancer ordeal, I now make a point of letting doctors (and nurses) know what they did well, what I appreciated or could have been done or said differently. I try to be clear in conveying my expectations, to let them know in advance what kind of patient I am going to be.
The relationship between a patient and a physician should be one of the most honest, devoid of silly pleasantries, fears or timidity. Too much is at stake for both.