Friday, February 03, 2006

To the Bedside Manner Born

A friend mentioned to me recently that she's thought about going to medical school, but believes she wouldn't have the necessary bedside manner. I think she was referring to the fact that she's a little shy — she's certainly not rude, though she is wicked funny — and I realized that the things that are predictive of a good bedside manner aren't exactly intuitive.

For instance, a good schmoozer is not necessarily good with patients. I myself have never been able to schmooze properly. Part of this is the way I was raised; my mother never taught us many of the standard social niceties, like introducing oneself, saying hello and goodbye, shaking hands. (Truly, we didn't say hello or goodbye in my family. People are often startled by the way my mother will just get up and walk away.) I can shoot the shit with people I already know, but when I first meet someone, I have to keep reminding myself, Now you say hello and smile. Ask how they're doing. Maintain eye contact. I said maintain eye contact! It can be exhausting. (I find that meeting fellow bloggers is less of a strain, I think because I feel like I already know them.) But give me a patient to talk to, and I'm better than Oprah. Because a good doctor doesn't talk; a good doctor listens while the patient talks. I am the Queen of the Pregnant Pause. It's a rare person who can stand a silence longer than I can. On a blind date, this is death, but in an exam room, it's pure gold. And by the time it's my turn to talk and try to explain something or sell the patient on my plan, the ice is long since broken.

This may come as a shock, but in general, the people who are attracted to medicine as a profession are not the social superstars. Doctors tend toward shy and quiet; they're the sort of people who are more interested in observing others than being the center of attention. And I have often noticed that the way doctors behave socially is rarely the way they behave in front of patients. Which is a good thing, because I've met some real wackos. I am a real wacko. But I can say: "What brings you here today?" and then shut my trap. (And no, nobody ever answers "the bus.")

Of course, there are some schmoozy types who go into medicine. We call them "surgeons." I'm kidding, but only a little. We attendings amuse ourselves when meeting new medical students by trying to predict each student's future career path. Schmoozy, hail-fellow-well-met men: Surgery. Assertive women: OB/Gyn. Geeky shy cerebral types: Internal Medicine. Sweet happy types: Pediatrics. Crunchy happy types: Family Medicine. Intense oddballs: Psychiatry.

I have a meeting with each student halfway through the clerkship so that I can get their impressions of how it's going and give them feedback on what the residents and attending are too chicken to tell them to their faces. (I keep a box of tissues handy.) There are really only about three scripts that I have to remember, because there are themes that recur. One of the most common is the Shy Student. The problem with the Shy Student is almost never bedside manner; it's the interaction with the other members of the team. If you don't speak up, people think you don't know anything, but what's worse is, your good ideas about and knowledge of your patients go to waste. I myself got the Shy Student talk my first month on clinical rotations as a med student. The attending said, "I'm giving you a High Pass for this month instead of Honors, because you haven't spoken up enough." I have to say, I was furious. I thought it was ridiculously unfair. I mean, it was OBVIOUS that I knew more than the other medical students! Wasn't it? Er, maybe it wasn't. So I started being Mouthy Student, or as mouthy as I could be. And it worked: I never got anything but Honors ever again. What I tell students to do is: pretend you're someone else, someone you think is a bit of a loudmouth grade-grubber. No matter how hard you try, you won't really become one, but you'll definitely crawl out of your shell a little ways, and it's not as painful as you think.

So if all that's preventing you from applying to medical school is your quasi-Asperger's personality, I say go for it.

15 comments:

B.E.C.K. said...

"This may come as a shock, but in general, the people who are attracted to medicine as a profession are not the social superstars."

Oh, I believe it. During my pregnancy, my two female OB/GYNs were very brisk and seemingly distant and unsympathetic (and one always had cold hands!). The male OB/GYN who actually delivered my son was very charming. Of course, he later lost his license after removing someone else's uterus or something, but that's another story. (eek) My male anesthesiologist was quite schmoozy and charming and I loved him...and not just because he was in charge of the good stuff. ;^)

Linda said...

Your stereotypes made me laugh... but they do seem to be generally true.

In any case, you are so right about the "bedside manner". Whether my doctors is shy or gregarious is not even remotely an issue to me. As a patient, I want to be *heard*, taken seriously, and treated kindly and respectfully. Ideally, the doctor will also be a critical thinker, a scientist. If your friend can manage those things, she'll be a great doctor regardless of how socially adept she considers herself.

cmm said...

Good advice. I have trekked through 3 years of med school the very personna of "shy student." And I've found I'm much better with patients than I am with my fellow students. Schmoozing is torture, though I'm trying to look at it as a useful skill, in the vein of knowing-how-to-change-a-tire.
Wish you were my preceptor. I could take "the talk."

Val said...

Great post! I have a "bedside manner" report from the other side of the railroad tracks...
Two wks ago, I had to go out of town so I entrusted my clinic to my colleague, "Dr M". Friday evening, he wound up doing an emergency splenectomy on a good client's 12-yr old dog. Happy ending -- he needed a blood transfusion but he survived & is currently thriving (I'll be rechecking him this afternoon) although long-term prognosis is somewhat doubtful bcz more than likely it was LSA (when owners have to pay for histopath out of their own pockets, we don't always get all the info we'd like, but that's another rant!).
Anyway, I spend quite a bit of time on the phone w/Mrs G, the owner, trying to cure her vague dissatisfaction...
No, it wasn't the bill (the most common cause of veterinary complaints), it wasn't the fact that dear Brutus did NOT have to euthanized on the surgery table & seems to have recovered & is enjoying life just fine...It seems that it was Dr M's bedside manner that was less than ideal!?!?!
(bottom line: he wasn't YOU) Guess I should be flattered that my clients love me so & find me so indispensable, eh?

thumbscre.ws said...

It's very heartening to hear that chipper, "I just LOVE to help people!"-esque extroverts aren't the only ones who can succeed in medicine.

The pediatrician comment made me laugh... I love all of J.Q.'s pediatricians, and they're all so damned sweet and bubbly that someone should bottle them. Well, except for that crotchety old bastard who was inordinately rough with J.Q. at his two-month well baby visit. I felt like giving that guy a very large dose of Children's Chewable Bite My Ass.

Mignon said...

I think all that's preventing me from applying to medical school is medical school.

And now that you've done your quickie guide to physician personalities, I realize the reason my first OB was slightly odd was because he had the internal medicine personality. At least it was odd/good and not odd/get-your-hands-out-of-my-cooter.

Feral Mom said...

My favorite doctor actually set her clipboard down when I got to an...err...emotional rough patch in the patient history. I LOVE your categories...now, what about anesthesiologists? They go either way for me. No, not like that. Our new pediatrician is OK, but the one in Chicago rocked. She had a baby five months older than ours, though, and would periodically gush "it just gets more fun!" between citing the lastest research.

Sara said...

"I think all that's preventing me from applying to medical school is medical school."
As a current medical student, let me just say - that is SO smart. I'm shy-ish, but posts like this one keep me aware of what to be mindful of next year when I start my clinical rotations. Thanks for the advice, DoctorMama.

Menita said...

What a smart, funny, interesting post. IS it so wrong that I have a crush on my quiet, cool OB? It's probably very, very wrong.

ozma said...

I'm so out of it I thought I posted and didn't. So that is one thing preventing me from applying to medical school.

It was interesting being treated by a super new ob/gyn (for a while) and seeing her screw up occasionally and then try to fake it. I totally know what that's like and honestly, after that I thought 'maybe I could apply to medical school.'

With respect to your post below...God, I felt for you so much! My body is now a snack station, primarily a snack station, asleep or awake. My sentience is totally secondary to its primary function. It sounds like you are better and I'm glad.

MFA Mama said...

Well that and my remedial math skills and fear of gross stuff...

Margaret said...

Still trying to crawl out of my shell...
The past couple years I've had a lot of doctor interactions. I thought the surgeons were the introverts: my hubby's neurosurgeon forgot to call me when he got out of surgery, so I thought he had died (totally socially clueless but a genius) and my son's ears nose throat surgeon was quiet in the office, but, on day of surgery, was unusually chipper, come to think of it. Are surgeons happiest when it's time to cut?

DoctorMama said...

Neurosurgeons tend to be a bit crabby. Maybe because they get tired of the joke, "Well, it's not brain surgery ... oh wait! Yes it is!"

Surgeons are WAY happiest when it's time to cut. And they prefer to schmooze with each other, not patients. Generally speaking, of course.

Anonymous said...

:-) :-)

very funny. I love your assignment into medical specialties. I'm a scientist/faculty memeber in a medical school, and I have to try to apply your predictions.

Great shy person advice, too. "Yes, I understand that you're not going to stop being shy, but try to pretend that your not, and that will do well enough to let you pass. "

bj

Anonymous said...

Oh this is too funny. I googled "why I became a doctor" and stumbled on your blog. I can't stop reading and I need to go to sleep!!!

I grew up in domineering household and I started to doubt whether my dream of becoming a doctor was really my own and whether or not I could be a good doctor given my anti-social personality type. Long story short...I am now 36 and I'm still trying to answer that question. I opted not to go to med school until I was certain of the answer as being a doctor is a grave responsibility. In considering a specialty I was leaning towards IM and fell out laughing when I got to your statement:"Geeky shy cerebral types: Internal Medicine"...that's so me!! In fact I see so much of me in you that I feel encouraged.

Thank-you so much for sharing parts of your life with us.