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Dynamic Chiropractic – November 17, 2003, Vol. 21, Issue 24

Bedside Manners: What Will They Think of Next?

By Louis Sportelli, DC
Say "ahhhhh" - or is that "grrrr?" It's hard to tell which sound is coming out of the AMA, responding to the recent announcement of the "test" for bedside manners that is to be completed before one obtains a license to practice medicine. This article is not meant to disparage medical physicians, but rather, to benefit doctors of chiropractic.

In the Sept. 23 issue of USA Today, an article appeared on the new testing program medical graduates will be required to successfully complete to obtain their licenses. The article suggests that medical students will be tested on empathy, listening skills and communication ability, among other humanistic qualities.

It was acknowledged by the medical doctors interviewed that today's bottom-line-oriented medicine often allows little time for conversation and pays handsomely for ordering high-tech testing. Medicine has been enticed by the wrong objectives and has fallen into the high-tech, low-touch model that essentially fosters a no-talk, no-touch, no-time, no-nonsense encounter with your physician in today's modern world.

I recall vividly that as a young DC, almost 40 years ago, a gastroenterologist befriended me and taught me a valuable lesson about being a caring person and a doctor. He was head of the G-I department in a hospital in our area. He had little fear of bucking the establishment by talking to a chiropractor, which was considered taboo back then. He had just the kind of professional disobedience and personal character he needed to keep him young and active. One day, he gave me a book titled Gut Reaction, subtitled, It's Not What You're Eating, it's What's Eating You. It was instructive to listen to this wise and successful medical GI specialist from the old school say, "If you listen to the patient long enough, they will tell you what their diagnosis is." However, he went on to say, "Unfortunately, we are not paid to listen; we are paid more to do procedures than we are to listen, so procedures take priority." Yet he never exchanged his humanistic model for money, nor did he succumb to the temptation to do procedures for money. He remained true to his early medical training and innate understanding of human nature. He recognized that many conditions afflicting human beings manifest themselves in the gut, and if the doctor takes time to listen, he or she will soon understand that the underlying problems are employment problems; a relationship gone sour; blind ambition; uncontrolled jealousy; family disputes; or - the list is as long as the stressors.

Even our language as human beings is a telltale sign of potential somatic illness. How often have you heard, "He makes me sick to my stomach," "You are a pain in the neck (or elsewhere)," or "She breaks my heart" - then found that illnesses of the GI tract, the musculoskeletal system or the cardiovascular system eventually manifest?

I have had the good fortune of meeting many medical physicians who possess and practice this humanistic quality we call empathy, and who have enjoyed rewarding careers. I am convinced the reward that comes from practice is the antidote to so-called "burnout." It is not something that is consciously learned, taught in school or described in textbooks. For some doctors, it is cultural; for others it is family upbringing; and for others still it is a recognition or awareness that being a doctor is something special and a trust that should not be violated. How very fortunate I was to develop a network of doctors who possessed these humanistic qualities and helped in the co-management of my patients during my career!

However, this is the rare and exceptional side of medicine; it is not the norm. The stereotypical MD has an aloof, impersonal attitude, and a paternalistic approach to health care. The doctor knows best - and that's the way it is!

If we really study the history of the organized medical propaganda machine, it is quite easy to understand that the cause of today's malpractice crisis in medicine can easily be attributed to the misguided images created by television and fostered by the AMA. A great book by Joseph Turow, Playing Doctor, is quite illuminating in this regard.

Test your memory: Remember the early medical doctor television shows, Dr. Marcus Welby, Dr. Ben Casey and Dr. James Kildare? These were the wonder doctors and the wonder years of medicine. Each of these programs focused on a magnificent doctor who would take the full hour of show time to treat one patient. He would see a patient who presented with an exotic disease, then do everything, including going to the place of the patient's employment to talk about the patient's condition; and he would finally convince the patient that he had the answer to the patient's problem. Lo and behold! He would "cure" the patient, and everyone would live happily ever after. (And no one ever saw this thing called "money" exchanged between the patient and the doctor.)

Imagine that world - no one ever died of his or her condition, no one was ever misdiagnosed; no one was ever rejected by a managed care organization; and no test was ever spared in the quest for truth, justice and the medical way. Oh, how fantasy was created and the seeds of unrealistic expectations were planted in the minds of the health care consumers watching these programs!

Well, that fantasy of medicine finally backfired a few years later, when these early popular medical shows, which became prime-time hits, created a false image of invincibility. Patients began to realize that their doctors did not spend the full hour with them, and did not exhibit the same compassion and expertise that Drs. Welby, Casey and Kildare did. They also could not always "cure" patients of every condition. So, what was the answer? "Let's sue `em." This was the start of the enormous malpractice crisis facing the medical community today.

Fast-forward your time machine to 2000: The prominent medical shows on television are Chicago Hope and ER. Their producers have no fear of depicting doctors having sex with nurses, or showing them impaired by drugs, alcohol or smoking - and there's that little operating room faux pas, indicated by organs sliding across the floor after being dropped by nurses assisting in open-heart surgery. Despite any similarity these events have to reality, the perception of omnipotence and infallibility has been so strongly imbedded into the psyche of the health care consumer that it is still difficult to erase.

Articles abound in peer-reviewed journals suggesting that "communication" style and bedside manner; friendliness of staff; personality; tone of voice; rapport; listening skills; and empathy will be strong indicators of whether or not a doctor will be sued.

The new test for medical graduates will take place in 2004, but it is being opposed by some in the medical community who apparently do not understand that a new paradigm of health care is upon us, and that old models are no longer applicable or desired.

The chiropractic profession is indeed fortunate: While we have also succumbed to the rapid pace of health care delivery with shortened office visits and less patient education, we have, by default, been able to withstand the onslaught of negative criticism. Most surveys dealing with chiropractic express, above all else, that patients have a "higher degree of satisfaction" with their chiropractic encounters than with other forms of health care. I suggest that one of the biggest reasons is that the very essence of chiropractic requires a "hands on" touching of the patient, and there is something to be said about the special relationship that develops as a result of a hands-on therapeutic intervention.

UCLA researchers recently reported "adults performing tai chi boost immunity to shingles." The study focused on shingles, but raised broader questions about whether behavioral interventions might play a role in protecting against other infectious diseases. While it is not clear why this phenomenon occurred, it is clear that there is a greater interest in the psycho-neuro-immunology aspect of health care and the "mind-body" connection.

Chiropractors have a golden opportunity to continue to provide wonderful health care, and to help return its humanity. Chiropractors have always been good communicators. Perhaps the bias and prejudice of the medical community demanded a more sensitive and caring approach to health care, or perhaps it is simply the fact that individuals who enter the chiropractic field are, by their very nature, empathetic, with that special quality of humanism. Whatever the reasons (which hopefully, we will find out some day), we can take some comfort in knowing that the $975 test for medical students on "bedside manner" should be passed by DCs with little or no preparation. It is a great feeling to see the health care paradigm shift, of health care, incorporating many of the traits that are second nature to doctors of chiropractic. Our only challenge is not to lose it by failing to see what we have, or to adopt a failed model of health care now being recognized as flawed and able to be corrected with human touch.

I commend the medical profession for recognizing the human side of health care and taking some action to correct it. While there may be some opposition, the leadership recognizes that unless its image is changed, it is in for a tough challenge.

Say - isn't that the same problem we have? Perhaps it is time for us to look at what the public perceives about doctors of chiropractic. Are we willing to take the test?

Louis Sportelli, DC
Palmerton, Pennsylvania

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