Comments on: Appropriate bedside manner http://www.medrants.com/archives/3544 Internal medicine, American health care, and especially medical education Sat, 11 Feb 2012 15:15:48 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Jill http://www.medrants.com/archives/3544/comment-page-1#comment-520592 Jill Fri, 25 Apr 2008 20:40:21 +0000 http://www.medrants.com/?p=3544#comment-520592 There's a line between showing appropriate emotion, and outright crying. I've seen a doctor cry when sharing information about a serious medical error with a patient's family, and I think it helped the family accept the information without feeling animosity toward those involved (it was not the doctor's error). However, in most other situations I don't feel it's appropriate. The focus should be on the patient, and what the patient needs from the interaction, not the doctor's feelings, or his/her need to vent about the situation. There are some patients it might help, but on the whole, patients seem to be a little shocked and put off whenever their doctor expresses any kind of strong emotion. There’s a line between showing appropriate emotion, and outright crying. I’ve seen a doctor cry when sharing information about a serious medical error with a patient’s family, and I think it helped the family accept the information without feeling animosity toward those involved (it was not the doctor’s error). However, in most other situations I don’t feel it’s appropriate. The focus should be on the patient, and what the patient needs from the interaction, not the doctor’s feelings, or his/her need to vent about the situation. There are some patients it might help, but on the whole, patients seem to be a little shocked and put off whenever their doctor expresses any kind of strong emotion.

]]> By: Patrick B http://www.medrants.com/archives/3544/comment-page-1#comment-520577 Patrick B Wed, 23 Apr 2008 11:40:47 +0000 http://www.medrants.com/?p=3544#comment-520577 This may be simplistic, but to me, nothing says "I'm truly and completely screwed" like my doctor bawling at my bedside... This may be simplistic, but to me, nothing says “I’m truly and completely screwed” like my doctor bawling at my bedside…

]]> By: Elizabeth http://www.medrants.com/archives/3544/comment-page-1#comment-520575 Elizabeth Tue, 22 Apr 2008 22:26:32 +0000 http://www.medrants.com/?p=3544#comment-520575 One of my vivid memories from the birth of my first child was the midwife in the back of the room crying when the OB came in to get my consent forms signed for the C-section. I'd been pushing for four hours (big, posterior baby). I don't know if those tears helped or hurt in the long run. They did make me feel like there was at least one person there who understood how disappointed I was at the outcome. One of my vivid memories from the birth of my first child was the midwife in the back of the room crying when the OB came in to get my consent forms signed for the C-section. I’d been pushing for four hours (big, posterior baby). I don’t know if those tears helped or hurt in the long run. They did make me feel like there was at least one person there who understood how disappointed I was at the outcome.

]]> By: Annon http://www.medrants.com/archives/3544/comment-page-1#comment-520574 Annon Tue, 22 Apr 2008 20:33:55 +0000 http://www.medrants.com/?p=3544#comment-520574 Fergie said it best - Big Girls Don't Cry. That goes for boys too. One can express compassion and empathy without crying. Jeff, the situations you describe are totally different in so far as you are not in the role of treating physician when you cried with the patients. I think Fergie would see that as acceptable. Fergie said it best – Big Girls Don’t Cry. That goes for boys too. One can express compassion and empathy without crying. Jeff, the situations you describe are totally different in so far as you are not in the role of treating physician when you cried with the patients. I think Fergie would see that as acceptable.

]]> By: Jeff http://www.medrants.com/archives/3544/comment-page-1#comment-520573 Jeff Tue, 22 Apr 2008 15:55:08 +0000 http://www.medrants.com/?p=3544#comment-520573 The most absurd thing I read in your post is that somehow crying will lead to burnout. In my experience, it is that consistent, sustained attempt to stifle any emotional response that has been most linked to burnout. Crying with a patient is not a decision, it is not voluntary: It is an escape when whatever is going on is just too damn sad. I cried once with a patient when she was telling me about the final moments with her dying child. The story was tragic; as a parent, it felt so real that I could not help but imagine myself in her shoes. The tears came and it was therapeutic for both of us. I would not plan or want to repeat a moment like this, but to have tried to remain stoic during this history would have been false and certainly would not have helped either of us. It's funny, breaking bad news, which I do a lot (and I feel I do well) does not bring me close to tears. I am able to be very clinical and for lack of a better word, professional when I am in that role. But when patients relate history that is especially touching, I do not back away from gettting a little misty. It is natural, it is a release, and I have never had a patient "freak" when they notice me dabbing at my eyes a bit. We do ourselves and our patients a disservice by trying explicitly to remain automatons. People will seek out caregivers with whom they connect. Expressing some emotion as you feel it, within reason, is part of that connection. The most absurd thing I read in your post is that somehow crying will lead to burnout. In my experience, it is that consistent, sustained attempt to stifle any emotional response that has been most linked to burnout. Crying with a patient is not a decision, it is not voluntary: It is an escape when whatever is going on is just too damn sad.

I cried once with a patient when she was telling me about the final moments with her dying child. The story was tragic; as a parent, it felt so real that I could not help but imagine myself in her shoes. The tears came and it was therapeutic for both of us. I would not plan or want to repeat a moment like this, but to have tried to remain stoic during this history would have been false and certainly would not have helped either of us.

It’s funny, breaking bad news, which I do a lot (and I feel I do well) does not bring me close to tears. I am able to be very clinical and for lack of a better word, professional when I am in that role. But when patients relate history that is especially touching, I do not back away from gettting a little misty. It is natural, it is a release, and I have never had a patient “freak” when they notice me dabbing at my eyes a bit.

We do ourselves and our patients a disservice by trying explicitly to remain automatons. People will seek out caregivers with whom they connect. Expressing some emotion as you feel it, within reason, is part of that connection.

]]> By: Twocents http://www.medrants.com/archives/3544/comment-page-1#comment-520572 Twocents Tue, 22 Apr 2008 15:10:24 +0000 http://www.medrants.com/?p=3544#comment-520572 First of all I think if I had just been given some BAD medical news it would be hard enough to deal with but if the DOCTOR started crying I would freak.... I mean if the DOCTOR is crying there must be no hope... I might as well get in the coffin now. I think that would scare me to ....well you know.... I just asked one of my female residents if she had ever cried over a patient, she said "NO" She felt it would make the patient think the doctor was weak..... Second, and this is NOT meant to be a sexist statement but just a statement of fact the article says 69% of med students and 74% of interns said they had cried. The article further states that most of these were women. I believe statistics will show that more women now enter medical school. Maybe this has increased the percentages??? Lastly the article doesn't say if those percentages who cried were in front of a patient and their family or if it was later at home or in the call room. I think that would be a big difference. Just My, Twocents First of all I think if I had just been given some BAD medical news it would be hard enough to deal with but if the DOCTOR started crying I would freak….
I mean if the DOCTOR is crying there must be no hope… I might as well get in the coffin now. I think that would scare me to ….well you know….
I just asked one of my female residents if she had ever cried over a patient, she said “NO” She felt it would make the patient think the doctor was weak…..

Second, and this is NOT meant to be a sexist statement but just a statement of fact the article says 69% of med students and 74% of interns said they had cried. The article further states that most of these were women. I believe statistics will show that more women now enter medical school. Maybe this has increased the percentages???

Lastly the article doesn’t say if those percentages who cried were in front of a patient and their family or if it was later at home or in the call room. I think that would be a big difference.

Just My,
Twocents

]]> By: CK http://www.medrants.com/archives/3544/comment-page-1#comment-520570 CK Tue, 22 Apr 2008 14:58:39 +0000 http://www.medrants.com/?p=3544#comment-520570 Crying in front of a patient seems pretty irresponsible. As you alluded to: if you're losing control, how do you expect the patient to handle things? Crying in front of a patient seems pretty irresponsible. As you alluded to: if you’re losing control, how do you expect the patient to handle things?

]]> By: Anon http://www.medrants.com/archives/3544/comment-page-1#comment-520569 Anon Tue, 22 Apr 2008 13:29:05 +0000 http://www.medrants.com/?p=3544#comment-520569 Warm and Fuzzy Or Cold and Technical? Warm and Fuzzy Or Cold and Technical?

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