I hope the surgeons reading this article don’t take offense, but some of you guys need to polish your bedside manner. A 56-year-old woman told me about her recent visit with a neurosurgeon, and she was quite upset. She had gone to see him at the suggestion of her family doctor, hoping to get some relief for her back pain.
The surgeon wasn’t very personable, to put it mildly. He reluctantly emerged from behind his desk, did a token 30-second neurologic examination but didn’t examine her back. He told my patient that her problems were not amenable to surgery. She was put off by his cursory exam, but to add insult to injury, he made a dismissive wave of his hand.
She quickly came to the conclusion that she wouldn’t receive relief or empathy at this office, but she couldn’t understand why the doctor hadn’t examined her back. She wanted some explanation of the neurosurgeon’s decision making. The explanation consisted of just four words: "I am a surgeon." She rephrased her question a few times, and each time received another "I am a surgeon." I would have liked to have been a fly on the wall, but she insists that she heard this refrain multiple times during the course of a very brief visit. After the sixth repetition, the surgeon was showing some signs of irritability.
I could have warned this surgeon that there are days when clinic just doesn’t go smoothly. I also could have counseled my patient. Many times, when I debrief my patients after their encounters with my surgical colleagues, they are upset that the surgeon didn’t seem to spend any time with them or pay attention to their complaints.
It isn’t fair, because invariably this ends up consuming my time. The surgeon saves 5 minutes by rushing off to see the next patient, but I lose 10 minutes trying to explain the surgeon’s brusque manner. I usually explain the surgical mindset as follows: In any new-patient evaluation, the surgeon asks a question, "Is this a surgical problem?" If the answer is no, the surgeon’s attention span falls off precipitously.
Ironically, this patient’s specialty is corporate communication, and she couldn’t believe that a neurosurgeon could be so devoid of interpersonal skills. She repeatedly demanded some further explanation of his decision. The exasperated neurosurgeon emerged from behind his desk a second time, and walked over to a light box that had MRI images of her spine. His intention to explain her MRI was good. For the sake of simplifying the discussion, he wanted to exclude extraneous soft tissues and focus on the spinal cord and nerves.
That was fine, but since he was talking to an overweight, middle-aged woman, he might have striven for a bit of diplomacy. My patient said that he made another dismissive wave of his hand and said, "All this is fat." This didn’t go over well. The surgeon was ready to end the discussion and send my unhappy patient back to her family doctor but, because of her superior communication and reasoning skills, she suggested a referral to a pain management doctor. The neurosurgeon gladly accepted this counter proposal, and I suspect he was glad to move on to the next patient.
Neurosurgeons aren’t the only surgical specialists lacking in bedside manner. One of my rheumatoid arthritis patients suffered a painful string of hip dislocations shortly after a total hip replacement. As painful and debilitating as this was for my patient, it also upset the fine sensibility of the orthopedic surgeon who saw himself as perfect and infallible. After multiple dislocations, the orthopedist’s mental anguish reached a crescendo, and he yelled at the patient in his waiting room, "I don’t know what you’re doing wrong! I’ve done everything right!" It must be hell to be so perfect.
My patient was admitted to the hospital. While the nurse was helping her get off the commode, her total hip replacement dislocated again. The nurse was a witness that my patient was following postop protocol to the letter. This painful and embarrassing episode provided a small amount of vindication for my patient. I thought she might cry, but she didn’t.
I’m always ready for tearful contingencies. I always make a point of having a box of tissues within arm’s reach in all my exam rooms because of an encounter that made an impression on me as a medical student.
A neurosurgeon in clinic was examining an older woman who had complaints of pain and weakness in one leg. The neurosurgeon checked her leg strength by having her raise her leg off the exam table against his resistance. His arms looked muscular in his surgical scrubs, and he easily pushed down on her leg until it gave way and returned to the exam table. Armed with this finding of weakness on physical exam, he turned his back on her to write a note in her chart. While he was writing with his back turned, he started to explain that he was going to send her for a myelogram to find out what was wrong with her leg. This was in the early 1980s, and an MRI was not an option.