Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Bedside Manner: Sunday musings…2/25/2024

1 Flow. Sort of the opposite of “block”. You know, like the writer’s block I thought I had until I sat down and looked over some notes I’d jotted down and the words started to flow so fast I can’t get a handle of which ones go where.

Is this what it’s like to be Steven King sitting at his keyboard?

2 Euderimonia. From Aristotle. A deep sense of well-being in which one feels that a life has meaning and purpose.

Think pre-EMR, pre-Meaningful Use, pre-Affordable Health Care Act private practice physician.

3 Brand. Why do vaccines have brand names? Wasn’t there just, like, one vaccine at a time back when we dinosaurs were the first wave of kids to get MMR, Polio, DPT and the like? Were there brands that were marketed to your friendly neighborhood pediatrician back then?

Sorry. Just seems super weird.

4 Book Report. My daughter in law Tes (TEZ) has this huge book club. Like a couple of hundred women reading books together huge. I should pay closer attention sometimes; she might be the admin member of her group, which would be a pretty big deal (I’ll ask when she arrives tonight to tipple with her hubby and her in-laws). Anyway, I’d started to read rather than have my books fed to me primarily via Netflix et al, and people ask about what I’ve read. So here’s another report: “A Monk Swimming” -Malachi McCourt.

Those of you who know me know that I spend an awful lot of time with “brain candy” like The Grey Man and the Jack Carr “Terminal List” series, alternating with Sci-fi that skews hard toward quantum physics and the multiverse. But every now and again I stumble across a book that latches onto my funny bone and just won’t let go. “A Monk Swimming” is one of those. Invariably I end up with one of these books while on a plane, usually while in the company of Beth, much to her chagrin. I am infamous for snorting when I laugh out loud, and this was one of those books that Beth literally made me put away while we were flying.

Malachi McCourt was the black sheep of the McCourt clan that also included Frank, author of “Angela’s Ashes”. Not a funny book. Malachi, on the other hand, made quite a life for himself by being the funniest guy in a room filled with all manner of people. He quite famously was one of the unnamed crew that aided and abetted the original Rat Pack (Sinatra, Martin, Davis Jr., Lewis, etc.). The guy’s stories are side-splitting funny, whether or not you are on a plane. He turned 91 last year and is probably pouring Manhattans at the retirement home this afternoon.

Do yourself a favor and pick up this gem. Be careful though. You want to drink your coffee or whatever while you are not actually reading. The book starts off hilariously with an explanation of the title (I snarfed on the plane) and just gets funnier from there.

5 Bedside. As in “Bedside Manner”, the antiquated term once used to describe a physician who had an easy way about themself while they communicated with their patients. It’s a term that’s been relegated to the historical junk heap, tarred by incriminations that it was little more than paternalistic and patronizing pulled off with panache. Of course, unlike days of yore during which so much of healing actually took place at the side of a sick bed, there’s not a whole lot of bed going on in modern healthcare.

I digress…

Bedside manner really means nothing more than openly showing that a physician cares about how a patient is feeling. Yes, sure, there was always that little bit of shade attached, an implication that the doc with a great bedside manner was actually hiding the fact that their medical acumen was rather thready, like describing your date as “a really good dancer”, but the reality is more likely that a “good” doctor with a “good bedside manner” was just like anyone else whose job made it necessary for them to be outwardly focused, focused on the patient/customer more than inwardly focused on what would ultimately lead to personal benefit.

In last week’s weekend edition of the WSJ there was a long piece on so-called “supercommunicators.” These individuals did something that I’ve translated as “active listening”: fully concentrating on what another is saying, and then validating that other’s thoughts/position/feeling by repeating the gist of what they said back to them. Even more so, after doing so they intuitively then ask if what they received was at least close to what the other person was sending. The front side of this is really nothing that your grandmother didn’t teach you when your were a kid: listen without interrupting when it’s not your turn to talk. It’s the second part of the equation, paraphrasing and confirmation, that elevate these folks to the “super” category.

Now this article was discussing communication in general, not focusing on the nuances of medical communication. Still, I kinda paid attention to my own habits in the exam room this last week when it was my time to “listen”. There’s a little caveat, of course, because a patient typically tells their story to a nurse or technician first, but paraphrasing the story obtained by another and seeking confirmation that your take is accurate is legit. Being a medical supercommunicator takes a bit more, though. There is an inherent information inequality due simply to the nature of the experience; no matter how much time you’ve spent with Dr. Google or messing around with ChatGPT or other AI’s, it is overwhelmingly more likely that I still know more about why you are in the office than you do.

The crux of having a good Bedside Manner is in how you take the next step in the conversation. How you demonstrate that you care about what your patient has told you. That you heard how much a problem is affecting them, and that you are committed to finding a solution. You, the doctor, may feel this deeply; your Bedside Manner is how you now project this. It is my contention that both House and Marcus Welby cared equally about the patients who presented themselves to be healed. Both were appreciated for their brilliance and the successes it wrought; only one was beloved.

I wish I had a newer, better term to describe a supercommunicator in healthcare. It’s my opinion that “Bedside Manner” has gotten a bad rap, honestly, but I get it. In the rest of the world’s non-medical communications there are some lessons to be learned from those docs who did/do have a “good Bedside Manner” for sure. Be an “active listener”, offering your communication partner the floor when it’s their turn to speak, paraphrasing and seeking confirmation so that they know that they’ve been heard. Like a doctor who sometimes has to prescribe a solution that is not really what a patient wants to hear, confirming that you’ve heard another does not require that you agree with them. Your response, agree or disagree, simply affirms that how they feel has value, too.

In the end we could all use a little bit of Marcus Welby’s manner at any “bedside”.

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