The Fine Art of Caring

A Conversation with Dr. Frank Spencer, Former Chair of the Department of Surgery

Why is a doctor’s bedside manner so important?
When a person is ill, one of the most important things he expects from a physician is sympathy—compassion. When a child is injured or frightened, it runs to its mother for care and reassurance. This basic instinct is lifelong. For centuries, practicing medicine was largely a matter of sympathetic listening. As scientific knowledge increased, listening decreased. As the care got better, the caring got worse.

Can this skill be taught?
Yes, primarily by example. Medicine is one profession that has the capacity to help people get better or well. For decades, I brought five or six third-year medical students under surgical rotation to my weekly outpatient clinic. I would tell them: “Your only job today is to observe. I want you to see how a physician talks to a patient.” My personal physicians, Dr. Philip Moscowitz and Dr. Martin Kahn, personify a great bedside manner. Each of them is “a doctor’s doctor.”

Growing up in Texas, did you learn any lessons that have served you well as a caregiver?
Absolutely. My boyhood was in the desolate Texas Panhandle—ranching country—with the nearest house a half-mile away. No electricity, no telephones. Strangers were always welcome, especially since they were the only source of news. Trust was almost automatic. Most transactions were done with a handshake. No contracts, no attorneys. Your word was your bond. If you broke your word, you might get shot!

Is there a secret to establishing a good rapport?
Treat the patient like your aunt or uncle. That metaphor can shape your entire manner and create a comfortable atmosphere. Even if you are in a hurry, sit down and talk to the patient eye-to-eye, on their level. Get the patient to talk about himself or herself. Does he have a family? What are her hobbies? Does he like to drink beer on Saturday night? This kind of small talk takes only a few minutes and has nothing to do with illness, but its effect on the patient is very strong. It conveys to him that the surgeon is not only interested in his disease, but in him as a person. I’ve often told students that when a patient recovers from a major operation, the surgeon gets more credit than he really deserves, for he is simply doing what he was trained to do. Accept the gratitude with courtesy and humility.

What’s the most important thing to remember about a patient?
When a patient sees you for the first time, he’s scared, especially if he’s seeing a surgeon. Don’t say something trite like “Don’t worry” or “Don’t be scared.” It doesn’t work. Reassure the patient that being scared is a normal, healthy reaction, and that you’re aware of his feelings. Long ago, I saw an intelligent patient for the first time who needed an aortic valve replacement. Throughout my description of the operation, he seemed abnormally calm and stoic. Finally, I said to him: “Aren’t you a little bit scared?” He responded: “Thank God, Doctor, that you asked me that question. I’m scared to death and I’m trying to hide it.” You tell the patient, preferably before he comes to the hospital, the mortality rate for the operation and the three or four most common potential complications. You also describe the chances of an excellent result, adding that a 90% probability is better odds than you’ll get at any race track. Gentle humor greatly reduces anxiety.