February 2002 Bulletin

Communicating with compassion

Don’t miss golden opportunity

By Sandra Lee Breisch

Often times, orthopaedists fail to show the compassionate side of doctoring, so says Barry C. Dorn, MD, a practicing orthopaedic surgeon and associate director of the Program for Health Care Negotiation and Conflict Resolution at the Harvard School of Public Health. And in doing so, Dr. Dorn suggests, they miss a golden opportunity to forge a stronger doctor-patient relationship.

Treating the whole patient

"Orthopaedists tend to be much more technology-oriented today and less humanistic in their approach to the patients and often fail to show compassion for the patient. But it’s not always intentional," explains Dr. Dorn. "They’re [orthopaedists] just more focused on the disease process going on than in the patient who has the disease."

As an example, Dr. Dorn notes the patient who comes in with a knee problem. "It’s very easy to look at X-rays and say to the patient, ‘You need a total knee replacement,’" he says. "However, that patient might have very little requirements for mobilization ability because he or she is not as active. That patient may simply benefit from a cortisone shot or a minor procedure that gets him or her by for a period of time."

What is important here, notes Dr. Dorn, is that orthopaedists "often fail" to ask questions about the type of orthopaedic care the patient would prefer based on that patient’s lifestyle. "When prescribing a certain treatment or surgery, an orthopaedist should demonstrate concern about the patient’s whole social milieu," stresses Dr. Dorn. "Find out what treatment is right for that patient given that patient’s economic, social and financial situation. Maybe the patient cannot afford to take time off work if you prescribe surgery versus the cortisone shot. Maybe the patient does not have a good support system in place at home if he or she needs home care. Maybe the patient simply does not want surgery. And if you do not know all of these answers, you really cannot give that patient appropriate advice."

Making human contact

Being compassionate also means orthopaedists should not treat each patient as the "next case," points out Dr. Dorn. "You’ve got to make human contact with the patient by shaking hands and greeting them properly. If the patient is your age, address the patient in the familiar, ‘hello, John Jones.’ This puts you on a level playing field with them. If the patient is much older, address the patient as, ‘hello, Mr. Jones.’

Personalize the medical interview by commenting on their profession. If the patient is a teacher say, ‘I see you’ve spent a lifetime teaching. That’s wonderful. Where do you teach?’"

According to Dr. Dorn, only after you sense the patient feels more comfortable with you and sees you as a compassionate, caring doctor should you suggest the patient put on a gown.

"Then, leave the room so the patient can disrobe and put on the gown," he suggests. "Allow adequate time for changing, then knock on the door to see if the patient is ready for you. When reviewing the patient’s medical history, pick out important things and comment on them. If the patient had cancer, say, ‘I see, you’ve been cancer-free for 10 years. That’s great!’ Express an interest in what the patient is presently experiencing, and then begin the examination. Afterwards, leave the room so your patient can get dressed. Finally, bring the patient into your consultation room—if you have one."

At this point, Dr. Dorn says, "You are now ready to negotiate the patient’s care. That is because you now have a clear idea of the person’s past and present history. You can also discuss his or her concerns, fears and how this particular muscuoloskeletal condition can be resolved in the patient’s best interest based on your communication with the patient."

Constructing a play

Dr. Dorn likens the medical interview to "constructing" a play. "The above scenario really sets the stage for the whole play. You can either establish a good relationship with the patient or a bad one—depending on how you stage things with him or her," he says.

By personalizing the medical interview, you are being compassionate to the patient, Dr. Dorn says, "By doing so, you are also not being prescriptive by saying, ‘Here you do this!’ Instead, you’ve said, ‘Here are your options, here’s what we can do.’ "Remember, the most critical thing is to ask the patient, ‘What do you think will work in your life?’ This is true compassion."

Communicate welcomes suggestions about future topics for the column on patient-physician communications. Send your suggestions to the Bulletin at AAOS, 6300 N. River Rd., Rosemont, Ill. 60018.

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