In Defense of Gentleness

Perhaps patients say that only out of desperation, when the kind doctor cannot find a cure for them, they decide that it is the kindness that is optional and the cure that is important.

These are either very frightened patients or people used to getting what they want. If there is no cure, they do not realize that at that point it is the gentleness and understanding of the physician they need the most.

I will go out on a limb here and generalize from my own experience as a cancer patient. I think that people who seem to be saying that beside manner doesn't matter, they just want competent treatment, are tired of being psychoanalyzed all the time, or of having their emotional pains "diagnosed." It's not that we want our doctors to be curt assholes. Actually, we all like a nice human-to-human chat, and we surely like the bad news presented in a kind and decent manner.

It's just that if you're sick enough for long enough, there are days when all you want is another goddam Anzimet, not a conversation about your "depression" or "anxiety" or "social isolation" or whatever label you want to hang on the emotional pain of having a long miserable life-threatening illness. Some very well-meaning people just don't know when to quit with that.

I get more out of my long days at the cancer center getting chemotherapy when the nurses take a minute to sit down and ask me what's playing on my ipod, which degenerates into swapping stories about the most cringe-worthy old rock albums we own, than I do out of the ones who get out the "care plan" and come over to ask me the medically-approved protocol questions designed to elicit verbalizations indicative of underlying insufficiency of compensation mechanisms, or whatever the jargon is this week. I know I'm not alone in that.

The other side of "dignity" is "privacy," and some of this is also, I think, just a cry on the part of the patient to leave me something--one little thing--that is private. My god, you disrobe me, you use x-rays to see through me, you poke and prod my genitals and digestive tract and every other part of me that I generally keep private. Some days, then, just an "innocent" question about how I feel feels, if you want to know, like you're not going to be happy until you've rooted through my emotions and exposed them to the bright lights of the exam room just like you have everything else. What I'm trying to say is that my emotions might be painful, but they're mine and sometimes they're very private and delicate and the only thing I have that doesn't make me feel like another body, another CBC, another bald chick in a backless gown. So you want to be careful how you approach asking me about them; if you ask in such a way that implies you have a medically-given right to it--instead of making an offer of compassion that I can engage with or not as I feel up to it today--you'll make me long for the heartless jerk doctor who doesn't invade my space.

Anyway, Ami, I think you're full of undigested bile-colored food leftovers. Us cancer patients do, in fact, "realize" that we need kindness and understanding. Duh. What we also realize is that we need what counts as kindess to us, as we are, not what counts as kindness to somebody else. In fact, your comment is a classic example of how our emotions get "diagnosed" instead of just accepted. Nothing makes me personally want to throw things at someone more than first being asked to describe a feeling, then being told that it's either stupid or juvenile, all in the name of being "nice" to me. Again, that's the kind of "nice" I don't need as a cancer patient. If you're a shrink and I came to you to have my mental state straightened out, that's one thing. But I'm here for something else.

As self-involved as cancer can make you, I still have some real sympathy for my doctors, you know. If the above sounds like you're damned if you do and damned if you don't half the time, you're right. But I'm also damned if I do and damned if I don't, so we're both in this awful situation together. You will have to work harder to interpret what I'm saying, probably, but, well, you're the doctor. Not every patient is highly articulate and introspective about feelings, and not every patient is going to say it clearly to you. On a casual hearing it may sound like the patient is saying "I want a competent jerk." I'm saying that you need to listen more carefully and hear something else.

Well said, Tanta. I think that it would help if we could all be that articulate. When I'm angry or depressed about being sick and in pain and the bald chick, the last thing that I want is someone to tell me that it's childish or selfish. I know it's not a useful emotion, but it is my emotion and I'd like to work my way through it without having it noted on a chart. Still, I want a doctor that cares that the news he's giving me is bad or that asking me to go back into the hospital "for a few days" is another few days away from my children. The Cheerful Onc is right too. This isn't a time to have a cold hearted jerk for a doctor.

btw doc, do your patients really ask you how long they have to live? I still can't imagine having the strength or the courage to get the words out of my mouth, much less to listen to the answer.

A simplistic response to a complicated subject: Bedside manner (i.e., Kindness and Compassion) is never overrated in any situation.

As a cancer patient, I know I appreciate a doctor or other health care provider with some personality and often appreciate some small talk, I tend to rate their overall competence more highly than those who are brusque or stay strictly to medical protocols.

Maybe that it is self preservation to expect nothing from a physician. My husband (50) just had a hip replacement. Our longtime GP checked on him on the morning after. When he asked him how he was doing my husband said " I hurt". The GP told him he was a pussy. Exact words. No lie. I bet we are charged for the visit, too.

Get another GP. Your health problems will eventually need the care of someone who will care. That guy doesn't deserve your loyalty or your money.

Two comments.
1. I think people who state that, mean that they would prefer that over a kind doctor who doesn't know what he's doing.
2. You may underestimate the value of your knowledge and experience. Most people cannot treat a malignant tumor of the top of their heads. When my brother had non-Hodgkins lymphoma, he had doctors that were both kind and good at what they did, but treatments didn't quite work the way they were supposed to. The cocktail that was so effective in other patients failed to induce remission. When that happens it does help to know that your doctors were good. Then there was no hope for you in the first place, rather than a nice person who just screwed up.