“Widow-makers” and Other Unfortunate Things Doctors Say

Melanie: In your book The Lost Art of Healing you devote a chapter to “words that maim.” Do you still believe that’s true today — that the words doctors choose when talking with patients can actually do damage?

Grandpa:  Not only do I believe words can hurt, but I have witnessed them to be lethal. You be the judge. It was early in my medical training and I was rounding with an attending physician who was managing a patient with a recent heart attack. The patient, a middle-aged male, was confined to strict bed rest, then the norm. He was restless, afflicted with numerous aches and was quite depressed after being hospitalized for several weeks. Forlornly he asked his physician. “Will I be home for Thanksgiving?”  The doctor responded breezily that he “would be lucky to be home for Christmas.” No sooner were these words uttered, then the patient lost consciousness and experienced a cardiac arrest. He was resuscitated with difficulty but died the next day.

“Oh doctor, one more thing . . .”

Melanie:  I want to thank Carolyn Thomas, a heart health advocate and creative dynamo behind the blog Heart Sisters, for providing inspiration for this post. In a recent comment on our blog, Carolyn wrote, “I suspect that this misplaced focus on the ‘chief complaint’ is also a major source of frustration for doctors when the patient waits until the doc’s hand reaches for the doorknob to leave at the end of a visit before asking: “Oh, Doctor, one more thing . . .”

Grandpa, I think Carolyn raises a great point! We’ve talked about the consequences for patients when doctors don’t listen, but what happens when patients don’t readily share, or only hint at critical info in passing at the end of a visit?

Grandpa: It means something unfulfilled, and one of many cues doctors need to be sensitive to. But no cue is meaningful unless the doctor is familiar with the patient.  Sensitivity to an unspoken word is magnified with intimacy, not alone with ‘the patient’ but with the human being who resides inside the patient.

Can a Handshake Reveal Health Problems?

Melanie: We’ve established that the first thing a patient says to a doctor (which you call the ‘chief complaint’) can be misleading. But, if not for that, how do you determine what’s wrong?

Grandpa: It begins with the handshake. Much information about personality and even the precise diagnosis can be derived from a handshake.

Melanie: Not buying it. I think you’re just trying to show off.

Grandpa: That too! My remark though is more reality than posturing. Handshakes can be timid or brisk, flabby or muscular, the flimsiest contact or a firm hold, fleeting or not letting go, palm moist or dry, on and on. These convey emotional states and even character. Sometimes, the handshake can be diagnostic of the underlying ailment.

Hearing More Than Words: The Magic of Listening

Melanie: Okay, we agree that doctors and patients need more quality time together, but you haven’t explained ‘how’ that’s possible.

Bernard: Time doesn’t have to be everlasting for a doctor to be responsive to a patient. It can be stretched through a host of measures—for example, by facing the patient at eye level, by not interrupting a patient’s narrative, and by observing non-verbal cues. These straightforward measures intensify time without extending it.

Melanie: What do you mean by non-verbal cues?

Bernard: Listening doesn’t just merely refer to verbal input. We each possess a powerful nonverbal repertoire based on body language and facial expressions. This may involve a tiny narrowing of gaze, a stare or diversion of eyes, a shrug of the shoulders, a tightening or unfolding of hands, a shuffling of feet, or uncrossing of limbs. Why is a patient looking away or visibly fidgeting? Is she hiding something? What’s going on?

What Patients Really Want

Melanie: Grandpa, what you’re saying about listening makes sense in theory, but you may not be aware of the dizzying pace of our modern age. In your day, it was easier to have an actual relationship with patients. Times have changed and freeing up an afternoon for the equivalent of an old-fashioned ‘house call’ isn’t always realistic for doctors or patients. And maybe something happened on the way to the clinic; maybe today’s patients don’t actually want relationships with their doctors. Sometimes, we seek expertise simply to make sense of the information we find online, ease our anxiety, and determine the right meds so we can get on with our day.

Bernard: It may indeed be a “dizzying pace,” but being upset about the doctor spending too much time with a patient? You are joking. Have you ever heard anyone complain of that?  On the contrary, people are upset with doctors for short shrifting time with them; for not listening to what is troubling them, for interrupting them after a few sentences, for looking at the computer screen rather than at them, for responding to telephone calls and pages while they are trying to rivet the doctor’s attention. In short, people crave trust and caring.