Measuring what it takes to be a good doctor

Dr. Pauline Chen's Doctor and Patient column in last week's New York Times explores the tests that act as gatekeepers for those who would pursue a career in medicine. The tests are used, in part, to determine who has what it takes to be a doctor. But do these test miss some key component of personality when it comes to measuring who will be a great doctor? Or is knowing the right answers on a test more important than any measure of personality?

Putting off difficult discussions

The New York Times had an article earlier this week about the difficulty physicians have with discussing end-of-life care treatment with terminal patients. The conversations are difficult, but important, and include such decisions as aggressiveness of treatment, resuscitation and hospice. Guidelines dictate that such discussions take place when the patient has a year left to live, so the patient can make decisions along with their families. But many physicians fail to have those conversations until much later. It is easier to suggest more treatment than to have a difficult conversation with a patient about his or her impending death. But failure to have those conversations may result in more aggressive treatment than a patient desires and death in a hospital when a patient would have preferred the comforts of home. While the conversations are difficult, physicians who learn to have these conversations help their patients live their last days as they wish.

The power of non-verbal communication

As a teacher, I love light bulb moments - the moment when you can almost see a visible light turn on a students face; the moment an abstract concept becomes concrete. The New York Times Cases section has such an article today: a first year resident learns the power of non-verbal communication in conveying caring to a dying patient. Effective, compassionate communication goes beyond learning the right words from a textbook. Real communication requires seeing, feeling and giving time.

The toll of malpractice

Between the holidays and teaching at Marquette University I have still had time to keep an eye out for insights into physician and patient communication. The New York Times had an interesting article last week about the emotional toll a medical malpractice case can take on the physician involved. While the article does not offer any solutions to how malpractice cases are handled or how they should be handled, the article does offer insight into how the cases affect physicians and how the possibility of future malpractice suits affects how physicians communicate with their patients everyday.

Respect and patient-physician communication

The New York Times Health section had an interesting article today, written from a doctor's perspective, about the power of names. The question is: how should physicians and patients address each other? Should physicians insist on being called "Doctor"? Should patients insist on being called Mr. or Ms.? Is a title a show of respect or detachment? When a physician or patient calls the other by his or her first name, is it a way of demeaning the other? Are we over-thinking all of this? The article generate passionate response from both physicians and patients.

The fact that the issue of titles is a concern at all shows the inherent difficulty in effective physician-patient communication. Both parties wield a certain amount of power: one of expertise in a field, one of ultimate control of their body and where they take it. There is a need for respect in this communication relationship, but also a need for intimacy. How do you balance formality and respect with the intimate nature of physician-patient communication and clinical exams? And what do you call each other when you do it?

Intimate acts of care

Registered Nurse Theresa Brown, a regular contributor to the New York Times Well section, offers insight into the intimate acts nurses perform in the care of cancer patients. The essay demonstrates that communication between nurses and patients goes beyond words, to intimate moments of touch, comfort and care.

Giving as an act of healing

The New York Times Well blog reviewed a book that explores the health rewards of giving to others. Giving to others isn't a medical cure for anything, but is presented as a means of helping patients cope and gives them hope. The book and the article cite some of the science and questions behind the idea of giving as a means of healing. But in this case, the science isn't as compelling as the stories of patients who have gained from giving to others. And we will all do well in this season to remember that the joy of giving is a joy unto itself, regardless of the benefits.