I have always believed that interpersonal relations are powerfully influenced by how you say something as much as what you say.
You can disagree with someone while not challenging them aggressively or impugning their character or intelligence. You can politely ask a question or do so with an implied threat. Human beings have evolved amazingly powerful ways of signaling each other their intentions through body language, tone and quality of voice, facial expressions, physical proximity, etc. You can intrude on another’s space and time or respectfully request their attention.
This truth plays itself out with tremendous clinical implications in the patient-doctor relationship. When patients are ill they often feel their autonomy and personal power has been compromised. Physicians should respect their vulnerability and interact with them with an empathic and compassionate awareness.
How physicians relate to patients has often been referred to as their “bedside manner”. Just today, while making rounds at JFK medical center, I entered a patient’s room for the first time. As usual I am conscious of doing so slowly, observing how they appear in bed, saying “hello” and introducing myself by name. I smile as well.
Mrs. “Jones” seemed to welcome me into her space. I proceeded to describe my connection to my medical partners who she had seen previously. This offered her a context in which to place me.
She smiled and quickly proceeded to describe her interactions with another physician “Metta”. She did not refer to him as “doctor Metta” and stated that she felt he had been particularly unprofessional with her. She described how he acted when they first met. Apparently he did not introduce himself to her and addressed the nurse who was present at the time rather aggressively. She perceived him as abrupt in his speech and demanding of her time. He proceeded to ask her questions but it was clearly “too late”—-she responded “you should already know the answer to that one!”
Dr “Metta” may have been in a bad mood. Or he might be unaware of how his approach to patients is detrimental to his interaction with them. He may be an excellent clinician with a deep grasp of medical knowledge. But Mrs. Jones will not see him again. However, because of his inability to relate to this patient, his professional abilities are rendered null and void.
First impressions do count in any human to human interaction. Now my questions to Mrs. Jones might have been just as basic as Metta’s. Perhaps she could have interpreted them as redundant as well. Perhaps she could have questioned why I didn’t already know these facts. But she didn’t. I connected with her first as a human being and secondarily as a patient. I demonstrated respect for her “space” as well as subconsciously asking permission to speak to her and examine her. Her granting me that audience empowered her. That relationship between us allowed the process to continue.
Whether or not I can offer her healing wisdom remains to be seen. At least the opportunity to do so has been created. So “bedside manner”…..does matter.