On the phone to the doctor’s
surgery, I speak with a receptionist.
‘I have a repeat
prescription, but I have to come every three months to renew it. I wonder if I could
have it on a six-month repeat?’
The dragon at the gate
shoots me down with the flames she breaths.
‘Definitely not. You’re
lucky to get a three-month repeat. Usually we ask patients to come every
month.’ I shrink back from the receiver at the thought she might revoke the
privilege but I’m too puzzled to stop.
‘Why is that? A doctor has
never once asked to see me about this prescription, to monitor me, not in several
years.’
The receptionist replies
with a little puff: ‘The NHS wastes millions of pounds on drugs because people
die with their bathroom cabinets full of medicines. Then their relatives bring
in bags of unopened drugs, and all we can do is throw them away.’
As someone with cancer in
remission, I’m stunned into silence. Perhaps she hears the echo of her words in
the pause, before she says, ‘I’m not saying you’re going to die, necessarily. But
we can’t go giving six month-prescriptions to people with terminal diseases.’
And there it is before me:
the uncertainty of my life weighed up against the brutal certainty of the NHS
official line, spouted by a member of staff who might benefit from a course on
bedside manner.
While bedside manner is
mostly considered the domain of medics, it’s relevant to many staff beyond.
Over the last twelve years, I have been initiated and confirmed as a regular
patient with doctors and support staff in several fields. From oncologists and
surgeons to obstetrics, plenty of GPs, nurses, porters, emergency doctors, paediatricians,
cosmetic surgeons and dozens of operational staff on the way, I’ve met a lot of
people with many variables of bedside manner at several hospitals.
There was the consultant who
delivered my first completely unexpected diagnosis of cancer with his head
bowed to his shoes. He told me I would never have children. There was the
pregnant intern who stood belly-to-belly with me when I was actually pregnant but also had cancer, just after a mastectomy,
and she wiped the optimistic smile from my face with pitying remarks about my bleak
outlook. There was the nurse who tried to issue a post-surgery injection but
refused to tell me what it was for, so a scene fit for a horror movie ensued in
which I refused to submit to his needle.
Over this time I learned
that any member of hospital staff, however influential or menial, has the power
to make a frightening experience either manageable or unbearable. I became the
evidence of how a doctor’s attitude towards his or her patient can trigger an
early self-discharge from advised hospital care, or prompt a regenerative
slumber after a reassuring conversation post-surgery. I learnt from both bitter
and grateful experience how a doctor can humiliate or empower a patient, and
how valiantly skilled a doctor must be to employ sympathy and gentle guidance
when his or her patient doesn’t know best.
The consideration of bedside
manner – sometimes referred to as ‘the Art of Medicine’ – is as ancient as the
concept of medicine itself. Its place in
medical texts dates back to the 4th century BC with the Hippocratic
Corpus, the original Ancient Greek medical works associated with the physician
Hippocrates. Back then, a doctor’s manner was the essence of a patient’s
treatment. The ancient words are still pertinent today:
‘The
physician ought to be confidential, very chaste, sober, not a winebibber, and
he ought to be fastidious in everything... He ought to have an appearance and
approach that is distinguished… Be
solicitous in your approach to the patient, not with head thrown back
(arrogantly) or hesitantly with lowered glance, but with head inclined slightly
as the art demands.
‘He
ought to hold his head humbly and evenly; his hair should not be too much
smoothed down, nor his beard curled like that of a degenerate youth. Gravity
signifies breadth of experience. He should approach the patient with moderate
steps, not noisily, gazing calmly at the sick bed. He should endure peacefully
the insults of the patients since those suffering from melancholic or frenetic
ailments are likely to hurl evil words at physicians.’
In Arizona, USA, one doctor has taken a step
further in training medical students in bedside manner. A fascinating programme
known as Horses for Healers is a system that uses the way horses mirror
body-language to teach trainee doctors to communicate with their patients more
sympathetically.
Dr Allan Hamilton, MD, FACS, is a Professor of
Neurosurgery , Professor of Radiation Oncology, Psychology, and Computer and
Electrical Engineering at the University of Arizona. A recipient of many awards
and honors, Dr Hamilton has life-long experience of horses and owns a ranch
through which he and his team facilitate various healing and teaching programmes.
He says: “Doctors would be far more respectful of
their body language and bedside manners if their patients all weighed 1,200
pounds; horses help medical students and professionals learn non-verbal
communication skills demonstrating the powerful voice of our body’s language.”
While some things haven’t changed since Hippocrates
issued his advice more than 1,700 years ago, the dawn of self-diagnosis in the
era of the internet really has tipped the balance of power and complicated the
relationship between doctor and patient. Like those horses at Hamilton’s ranch,
we have all our own peculiar history, own levels of knowledge and our own
expectations.
At regular follow-up
appointments with my breast cancer surgeon, I often reported worrying abdominal
pains. He listened patiently, questioned me about their nature, and monitored
them. And then, at my last appointment, he leant towards me in a
conspiratorial way, and said with the skill of a doctor who
had clearly taken the time to understand me through three surgeries and many
years:
‘Well, it can’t be cancer,
can it, because if it were, you’d be dead by now.’ We laughed, I went home
reassured, and the pains disappeared. His bedside manner had cured my anxieties and my symptoms in a way many wouldn't like, but tailored just to me.
If I were one of Hamilton’s
horses, I may well have stampeded over some of the individuals who have played
a part in my medical care. But my surgeon, I’d have been eating out of his
hand.
