From Bedside to Post-it Note

For some physicians, at what point in their career does a transition occur from considering their participation in patient care as a remarkable privilege to simply a quotidian task? As a future physician, the question is of particular interest to me. Bright-eyed, curious and eager to assist, my current outlook on patient care is one of excitement and compassion. My need to help can be traced back to childhood, as I walked along the sidewalks on rainy days, meticulously placing worms back in the grass to prevent their demise by the impending heat of sun. What could cause this innate compassion, a common factor for pursuit of a medical degree, to be driven to the wayside?

Out of the plethora of specialties that exist in the medical field, oncology must rank among those which require the most gentle and attentive of bedside manners. They are, after all, giving one of the scariest diagnoses, and treatment options can often feel to be a greater adversary than the disease itself. For many, the word “cancer” immediately elicits images of a sickly, bald-headed patients, nauseated and feeble as drugs systemically kill both their healthy and the diseased cells. In acknowledging the mere strength of the word, how it commands respect and evokes fear– this fact alone should necessitate that the physician possess the ability to deliver such a life-altering diagnosis tactfully, with great sensitivity and care. Yet, the very antithesis happened to my friend. Abnormal symptoms and suspicious blood work landed my friend at his local cancer center. There he sat with his wife and daughter, anxiously waiting to speak with the physician whom he hoped could create a more cohesive picture with the seemly disparate, and unusual clinical puzzle pieces. With each tick of the clock, both he and his family grew more uneasy, restless, concerned. Three hours passed before the secretary appeared telling them, “you can leave,” And they would be contacted in a week with information about a follow up appointment. Both his wife and daughter, health care professionals, were perplexed. Clinical findings showed his blood count was abnormally low, his job required extensive travel to infectious disease centers, and they worried about the safety of this combination. Exasperated with the onslaught of questions, the secretary exited the waiting room, and they assumed she’d be returning with the doctor. Instead, she returned with a post-it. Scribbled on the square, yellow paper were the letters – CLL. Chronic lymphoid leukemia. They received a diagnosis of cancer by the means, and equivalent thoughtfulness and effort that one writes a grocery list. The next day, a different physician gave a new and correct diagnosis of Stage IV Mantle Cell Lymphoma. If left untreated, his cancer would have killed him in less than two weeks. If left in the callous hands of Dr. Post-it Note, one of the last weeks of his life would have been spent misdiagnosed, waiting for an appointment.

The importance of bedside manner has been taught by medical scholars for 1500 years, with the Hippocratic Oath originating in the fifth century BCE. Is it technology that has changed the science and art of medicine? X-ray, CT, MRI – all allow the physician to bypass the physicality that once grounded the patient exam. No need to palpate the abdomen with your hands when the scan can provide a clear, internal view. Perhaps it is insurance companies dictating the time spent with each patient, or the slashing of reimbursements that creates haste in the patient room. Whatever the answer may be, it is the next generation of physicians, like myself, that have the potential to reconcile this disconnect between science and healing, giving patients care founded on humility and compassion as much as reason and evidence. Until then, patients must advocate for themselves – ask questions, gain second opinions, and most importantly, refuse care of any physician who doesn’t treat them with respect.

Both saddening and enlightening, this experience will be filed away as a constant reminder of the type of physician I do not want to be. More importantly, its message will stay with me during each patient encounter, serving to make me a better physician who values the difference a great bedside manner can make in patient-care.