Who is This Doctor at My Bedside?

Recently, a friend went to the emergency room with complaints of severe GI pain and was admitted to the hospital. Naturally, she was worried about the cause of her symptoms, which she had been experiencing on and off for 6 months. Under the care of her family doctor she tried several medications but none seemed to alleviate her pain entirely. Now, the doctor who she had known for many years and trusted was no longer involved in her care. Instead, a hospitalist appeared at her bedside and would be in charge of the case.

For patients and their loved ones who encounter the hospitalist model, it can be quite unsettling. This is not to say anything negative about these doctors because they are well trained. Most challenging in these circumstances, however, is building a working doctor-patient relationship in a relatively short period of time.

As much as patients can be uncomfortable asking questions or expressing concerns to any doctor, hospitalists may also find themselves in an awkward position. They do not know the person who is the patient but may be the first doctor to present a serious or terminal diagnosis. Receiving “bad news” is shocking to patients and not heard in complete sentences. And, delivering this news is extremely challenging for hospitalists.

Fortunately, my friend did not have a life threatening illness. But, her experience jogged my memory of what a hospitalist at a Massachusetts medical center shared with me about delivering bad news to someone he met only a few days earlier.

He said, “I hear a challenge from these patients for physicians to “walk” with the dying patient, to be present, to share the experience. Cure is no longer the issue so neither is failure, except the failure to be compassionate and present. In my experience, the patient who has accepted the terminal nature of the illness still wants to live, to be heard, to be acknowledged and to be loved. Every doctor and caregiver can offer these gifts and thereby help and heal.”

It appears to me that communication barriers to a working relationship between doctor and patient, whether in or out of a hospital, can be bridged by open and honest conversations about the circumstances in which they both find themselves.