Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists, interested bystanders are also welcome. A place to talk; no one has to listen.
Thursday, September 13, 2012
Saying the Right Thing
I just read a very touching article on the New York Times Well blog by an oncologist who talks about a visit with a deceased patient's wife and children. I finished the article, The Widow's Doctor Visit and thought, if I ever have that illness, I want this man to be my doctor. I never think that, but this oncologist's insight into what a grieving family is going through is remarkable, as is his willingness to openly discuss it. He tells the widow that the patient was lucky to have such a supportive wife. He tells the son his father wore the same shoes, so he too must be a spiffy dresser, like his dad (oh, actually the writer said 'fancy' but I like spiffy better). He tells the children that it's okay if they are a little glad that they don't have to watch their father suffer and to have their worlds revolve his medical condition. He has some sense of what it is that families are looking for, and that's nice.
But it isn't actually true that I would want this guy to be my doctor. The truth is, if I had a bad illness, I'd want the doctor with the best outcomes, not the doctor with the best beside manner. And really, I know the I know this doctor can write a moving article (this is worth a few points in my book) but it doesn't mean that his interpersonal delivery is wonderful -- it may be and I certainly liked him from what I read. But if I had a chronic illness, or one where a bad outcome was virtually guaranteed, then I'd want the best bedside manner and the doctor who could pad the ride with some kindness and sensitivity.
They don't teach you in medical school to tell the wife who has just cared for a terribly ill husband that he was lucky to have her. They should.
What do you think? Oh, and do surf over to the Well blog and read the article.
Then, if you want, surf over to KevinMD and read this article and let me know if I was mistaken to find it offensive. I just couldn't get a feel for the author's tone.
Posted by Dinah on Thursday, September 13, 2012
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I read the Salwitz piece. I believe I DID get a feel for the tone: paternalism? Paternalism is not dead in medicine. Not even close to being dead. In fact paternalism is feeling much better. In fact, paternalism believes it will go take a walk. [Gratuitous Monty Python reference]
It was a pretty dull piece. I do agree with Rob's assessment. I did laugh a bit because so often doctors make the worst patients. I know doctors who do not visit doctors believing they already know it all. They wait until they are sicker than anyone ought to be before seeking out a doctor.
Yeah, the Kevin MD article was condescending. If it had just been random, dumb mistakes it would have been funny...but it was about people rupturing their colons, nearly fainting from serious heart conditions, etc. That made it less funny.
It might be a good article for people who love the Darwin Awards. I feel guilty when I see a person die in a Darwin Award clip and laugh. I laughed so hard at one once that I thought I must be a psychopath.
I agree that the Kevin MD piece was both paternalistic and condescending (are they synonymous? ... possibly). I was also struck by two of the examples, that involving the removal of staples and that involving the attempt to reinsert a gastric feeding tube - surely some patient education was warranted in both, if not by the physician (who doesn't mention it as a possibility), then by nursing/post-operative support staff?
....and how much more essential it is for a psychiatrist to be able to say the right thing at the right time.
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