Re: Guest Post - Bedside Manner


That story is, indeed, fascinating.

Posted by: x.trapnel | Link to this comment | 10-25-12 10:22 AM
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We've been to that ER for: 2 episodes of croup (one requiring an evaluation stay the next day); chest x-rays after inhaling water at the pool; broken collarbone; broken forearm; precautionary x-rays on shoulder. That list sounds like a lot but that's over 17 child-years so once every ~3 years per child.
Anyway, the doctors are pretty good and of course they have all sorts of things to keep kids happy, but the waits are often the most frustrating thing. For the broken forearm we were there on a busy night and it was about 8 hours before we were seen.
IOW, people should stop writing articles about how great it is there so that I don't have to wait so long.

Posted by: SP | Link to this comment | 10-25-12 10:37 AM
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We've been to med-clinics like these a lot more than the actual emergency room. The hours are extended and there are several locations, and they can take x-rays, deal with ear infections/eye infections/etc. We have been sent over to a hospital when we needed a cast, however. But we didn't have to wait in the emergency room. We had an appointment or something.

Posted by: heebie-geebie | Link to this comment | 10-25-12 10:58 AM
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What a great con artist that doctor would be. Or stage magician.

Posted by: clew | Link to this comment | 10-25-12 11:14 AM
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4: Yeah, I have found his methods very useful.

Posted by: Jerry Sandusky | Link to this comment | 10-25-12 11:28 AM
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Seriously, this is an example of a technique that will not transfer to other doctors. There is nothing creepier than a middle aged person trying to show interest in a child by insincerely complimenting clothes, hairstyle, drawings, etc. It can creep the kid out too.

Posted by: unimaginative | Link to this comment | 10-25-12 11:34 AM
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Oh, it's not impossible to learn how to charm kids. It looks creepy and awkward when someone who's not around kids much does that kind of thing badly, but this is talking about techniques for doctors who are going to be using them frequently.

Posted by: LizardBreath | Link to this comment | 10-25-12 11:36 AM
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Our children's hospital has a child life specialist on duty who would have been assisting Mara if he or she hadn't been with someone else, and I think they take on the role of creating rapport and coming up with a non-threatening treatment plan.

We waited a good while, but there didn't seem to be many doctors on duty and one of the kids walking out had bloodstains all over his jeans, so I know that's prioritized over a kid with pica who has abdominal problems. Mara also has a lot of fear about anything medical that way predates us and I don't know where it comes from, but we'd been able to avoid it in her previous ER visit (fast-moving hives on a Sunday) and I hoped she'd do okay there.

I really liked that Mara's doctor, a young black man, was gentle with her and let her make some decisions about how the exam would work, figuring out ways to work around what was freaking her out a bit. When she refused to let him finish his exam, he and the nurse (young, female, white) went to look for the child life specialist but I said I'd rather we handle it ourselves than wait longer. The nurse brought in a light-up toy where little planes spun around that Mara could control with her hands while I held her and the nurse played with the toy too and Mara relaxed enough to get the exam done, but with understanding and some participation on her part.

Then we had to do x-rays and it all went to hell and four of us, including myself and her nurse, had to put on aprons and hold her down on the table because there was no way she could lie still herself or stand still to get an upright one. But she didn't hold it against us much once she was done sobbing, and we went back into our room and she dozed off in my arms.

I was probably impressed by this because it goes along with my general parenting tendencies to emphasize ownership of one's own body and to present things as either-or choices to give the kid some buy-in, but I do think it worked very well for Mara. Plus now we have a story about "And THIS is why you don't eat stuff that's not food!" that will probably have no more impact on her than all the times we've told her that we worry because non-food items could make her sick in the long run. We already had a referral for her to meet with the feeding team there to work on some sort of pica treatment plan, but maybe this will speed the process or something.

Posted by: Thorn | Link to this comment | 10-25-12 11:47 AM
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The concept of "bedside manner" really worries me. I look around the medical school that surrounds where I work, and I don't see a lot of people who seem like they are likely to have good bedside manner. The main requirement for getting into medical school is the ability to memorize limitless numbers of facts. Then once you get in, the other keys to succeeding are A) ability to schedule one's time well, and B) self-confidence in competitive and tense situations.

It seems like everyone is a Type A personality with a rigid work ethic. I would not be surprised if literally every medical student here exercises 8 or more hours a week. This is good in a way obviously, but it will make it hard to communicate with and relate to the average patient.

Posted by: Cryptic ned | Link to this comment | 10-25-12 11:48 AM
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OTOH, nurses with good bedside manner can make an amazing difference.

Posted by: heebie-geebie | Link to this comment | 10-25-12 11:51 AM
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My brother's (ex?)girlfriend is doing her residency for OB/GYN stuff and just keeps getting more tattoos and generally being a very smart, driven hipster beach bum. I think that will work out well for her and her patients, but I'm not sure how representative of anything she is.

Posted by: Thorn | Link to this comment | 10-25-12 11:53 AM
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She didn't eat a puzzle piece, did she?

Posted by: SP | Link to this comment | 10-25-12 11:56 AM
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Nah, we haven't read that Curious George book, or at least I haven't read it to her. Didn't want to give her any specific ideas.

Posted by: Thorn | Link to this comment | 10-25-12 12:03 PM
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We have one Curious George book which uses a handful of semi-old-timey-borderline-awkward phrases which totally trip Jammies up, to my great amusement. Like "How good that George was a monkey!"

Posted by: heebie-geebie | Link to this comment | 10-25-12 12:06 PM
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I'm ambivalent about "bedside manner" - part of me thinks it's basically equivalent to political manipulation bullshit at best (ooh, here are some vacuous warm words) and at worst something ill defined that just isn't implemented. And then I occasionally have to deal with an actual doctor, and to be frank anything would be an improvement, from Dr. Prussian Strutting Consultanazi doing his special authoritative whisper to his colleagues at the foot of my relative's bed so neither of us can hear what they say except when he does his special shouting concernedness from the end of the ward thing to Concerned GP Who Makes Tech Weirdo Me Look Like Bill Clinton demanding to know if a liver function test would "change my behaviour" (it was entirely OK, I did lose 8kg though, but then it wasn't him who accused me of being fat).

Basically, men should be banned from the profession.

Posted by: Alex | Link to this comment | 10-25-12 1:28 PM
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I once had a (male) oncologist with excellent, inclusive, informed-consent manner, with a (female) nurse like a Nurse Ratched parody. Go figure.

Posted by: clew | Link to this comment | 10-25-12 1:44 PM
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5 was too soon for me.

Posted by: clew | Link to this comment | 10-25-12 1:44 PM
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I'd like to speak up, with clew, for the right of professional women to be insensitive assholes.

Posted by: LizardBreath | Link to this comment | 10-25-12 1:49 PM
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Satisfied patient = bad communication?

Posted by: Minivet | Link to this comment | 10-25-12 1:53 PM
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As someone who is currently trying to figure out how to self medicate in preparation for a drive that will take me to the turf of the professional women who are insensitive assholes who are making me miserable, I too will pipe up with Clew.
Before this year, a lifetime of experience had made essentially hate doctors---after my first two great pediatricians, everyone was awful, and then there were the ones who were just awful to my mother. But this year I joined the local managed care hospital nonprofit thingy---having heard how terrible it is 'to be a number' and basically with the attitude of 'fuck it, I get shitty medical care anyway, I might as well pay less in insurance.' It's been an incredibly pleasant surprise. Amiable personable doctors who seem to be taking an active interest in my health, efficient electronic communication, zero paperwork related friciton. I sometimes feel like I'm over there all the time, but that's b/c they're so insistent on fixing all the things I have let go to hell over the years. It's like I entered some kind Atul Gawande wonderland. Despite all my grief and trauma this year, I'm actually more positive about my future health (and fittness and exercise and diet) than I have been since I was in college.

I google stalked one of my doctors b/c she had an interesting name, and it turns out her sister is a prolific blogger who shares a lot of information about the doctor. From this I found out the doctor spends lots of spare time reading books about reforming healthcare and being a better doctor when she's on vacation. (there were Christmas photographs of the doctor curled up with a pile of books.) It was really reassuring.

Posted by: Ile | Link to this comment | 10-25-12 2:02 PM
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I've been saying it for years, in the future doctors will be replaced by nurses equipped with artificial intelligence systems.

Posted by: Unfoggetarian: "Pause endlessly, then go in" (9) | Link to this comment | 10-25-12 2:23 PM
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This is a fascinating article. Really, a lot of the techniques the doctor uses apply to all kinds of situations, not just children or medicine:

" creates a sort of confusion for her. She's expecting me to go right for [her head] yet why am I talking about her shoes? Well, confusion is sort of the beginning of a hyper-suggestable state. So this is a beginning of a way to begin to make contact."

I use an approach like that as a general human-management approach in all kinds of intense situations. It sounds like this doctor is someone who's by nature very good at reading people and guiding their emotional energy, and who's ended up applying those skills in a children's-medical-services context. Which is a great place for a person like that!

Posted by: freight train | Link to this comment | 10-25-12 7:31 PM
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Two thumbs up for specialized pediatric ERs. We used the one in [our old stomping grounds] medical system a lot - well as much as you'd expect with 3 young kids. And they were great, as was the pediatric ICU, which unfortunately we experienced for one miserable week when our littlest was one (everything came out well). Actually, my wife and I had some visits to the adult ER, as well, and it was good too. Go heels.

Posted by: simulated annealing | Link to this comment | 10-26-12 12:43 AM
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I bet I've dealt with more doctors than most of you amateurs. What they have in common is usually privileged, generally entitled backgrounds; what they don't have in common is everything else. They're people, you get all kinds.

Posted by: chris y | Link to this comment | 10-27-12 4:30 AM
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We did the ER thing again last night (UTI) and were able to spend some time with the excellent nurse and did meet the child life worker. Mara was fantastic and relaxed throughout her exams, I think because the doctor and nurse the previous time had made things so comfortable for her. These doctors weren't as skilled in building rapport and the one who claimed to see Elmo inside Mara's ears was unimpressive, but they could have been a lot worse and got the job done.

I forgot to say this before, but one thing I especially appreciated the fist time was that the nurse brought stickers after Mara got through the exam she didn't want and she had both Thomas the Tank Engine and fairies with no implied judging about which Mara might prefer.

I am so ready for a full night's sleep. Lee is off getting a strep test, so we're a mess in general. Glad things will be better for Mara now, though.

Posted by: Thorn | Link to this comment | 10-27-12 8:47 AM
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