A Passionate Doctor Becomes A Patient Who Needs Compassion

(Originally published on Bedside Manner at Everyday Health)
I recently read in the American Medical Association’s newsletter, an excerpt from Thomas Graboys, MD’s recently published memoir, Life in the Balance. Dr. Graboys is a nationally renowned Boston cardiologist who at age 61 stopped practicing medicine because Parkinson’s disease was aggressively attacking his body and his mind. He was cherished by his patients not only for his clinical skills (he was part of the “Dream Team” of cardiologists assembled to care for Boston Celtics star Reggie Lewis after he collapsed on the court) but for his humanistic approach to practicing medicine. Now, as a doctor with a devastating disease, his hard-won wisdom is incredibly poignant. Here are a few excerpts from his book:

A few days before a regular six-month appointment with my neurologist, John Growdon, in late 2006, I was asked what, if anything, I would like him to do for me that he wasn’t doing already. My answer was quick and sarcastic: “I’d like him to call me every month to ask how I’m feeling,” I snapped, as if a busy doctor with hundreds of patients in his care would have time for that.

But the more I thought about it, the more I realized that my glib remark cut close to the truth. I want to be on his radar screen. I want him to be thinking about my case, not just when I am in his office, but when he reads about new treatments and new insights into Parkinson’s and Lewy body dementia. I want him to be turning my case over in his head once in a while, and I want to know that while there is nothing that exists today to reverse my dementia, he is thinking from time to time about how to make my life better.

Here Dr. Graboys writes about those small, but precious, gestures that can make all the difference to a patient.

In my own practice, I developed a keen sense of just how deeply appreciated and how profoundly comforting small acts of kindness and mindfulness can be for the patient and his or her family. Dropping in on a hospitalized patient at the end of a busy day, not to check the chart or to do a quick exam, but just to say “Hello, I just came by to see how you are. Is there anything you need?” Calling a patient at home a few weeks after their annual visit to see how their new diet and exercise program is progressing. Writing a letter of condolence to the family of a patient who has died (a sorely neglected necessity, in my view). These small acts say to the patient and the family, “I know you ache, I know you suffer, I know you are in pain,” and allow doctor and patient to meet on the common ground of their mutual humanity.

That section reminded me of what Kenneth B. Schwartz, a Boston healthcare attorney, wrote in a story for the Boston Globe Magazine about his struggle with lung cancer, which he succumbed to in 1995. “I have been the recipient of an extraordinary array of human and humane responses to my plight. These acts of kindness - the simple human touch from my caregivers - have made the unbearable bearable.”

Compassion Leads To Fewer Medical Errors

(Originally published on Bedside Manner at Everyday Health)
More thoughts on the benefits of compassionate care. In a previous post, I wrote about how studies have shown that compassionate care leads to superior decision making, increased compliance with recommended treatment plans and better health outcomes. So…a few new studies showing that arrogant and abusive behavior by physicians contributes to medical mistakes shouldn’t come as a surprise. A New York Times story points to a couple of surveys underlining this connection, including one that queried healthcare workers at 102 non-profit hospitals. Some 67 percent said they saw a link between disruptive behavior and medical mistakes and 18 percent said they knew of a case where a mistake was made because of a doctor behaving badly. What’s the connection between a rude, imperious doctor and a dosage error? When the atmosphere is tense and anxious, a nurse may be too intimidated to speak up if she thinks she detects a mistake, for example.

The Joint Commission agrees that enough is enough. As I’ve mentioned in the past, the agency that accredits hospitals is requiring that by January 2009, every facility they accredit must have a code of conduct in place and a process for managing those who ignore that code. A physician friend of mine had this to say about such codes: “These sorts of things are very hard to enforce. What do you do with a surgeon who generates millions of dollars for a hospital? They’ll take their cases elsewhere, because if you’re that valuable, any hospital will hire you.”

Is he being too cynical? Can you mandate good behavior?

Medical Error An Apologies: Why It's Hard For Physicians To Say They're Sorry

(Originally published on Bedside Manner at Everyday Health)
A couple of familiar faces popped up on the New York Times website recently, in a video op-ed called “Physician, Say You’re Sorry.”

It was a moving 4-minute mini-documentary exploring an aspect of medical error that doesn’t get talked about much: apology. The piece was made by Tom Delbanco, M.D. and Sigall Bell, M.D., who both teach at Harvard Medical School and work at Beth Israel Deaconess Medical Center in Boston. An internist, Dr. Delbanco is well-known for his work in patient-centered care. Dr. Bell, an infectious disease specialist, has developed a fascinating curriculum called Reading, Writing, and Reflection: The New ‘3R’s’ of Medical Education?” that infuses the clinical experiences of third year Harvard Med students with a healthy dose of the humanities. The Schwartz Center helped fund the development of the curriculum, which is how I know Dr. Bell.

The video intersperses sound bites from Drs. Delbanco and Bell with those of families of patients who have been seriously injured by medical errors. In a couple of cases the patient died.

“We’ve been so arrogant in our profession for a long time,” says Dr. Delbanco. We think we know what patients want. We think we know what they experience, so we don’t ask.”

Dr. Bell talks about how both doctors and patients and their families suffer from the same emotions after a mistake - fear, guilt and isolation - yet they can’t bridge the communication chasm that often occurs after such an event.

“There isn’t a forum for talking about error,” says Dr. Bell. “Most clinicians go through all of medical school, residency training, and clinical practice as Attendings without a single session teaching them how to sit by beds and conduct this kind of conversation…doctors are counseled by insurers, institutional policies and risk management groups not to use certain words. In that setting the pressure to choose the right words can be so intense that some clinicians choose no words at all, and that results in silence and what we learn from patients is that compounds the harm.”

One patient, who later died as a result of an error, put it simply: “you have no idea how far a sorry will go.”

Have you ever been injured by a medical mistake? Did you receive an apology?