Improving Education 277
Unfortunately, countervailing pressures compelled many doctors to
feel too hurried to obtain full histories. In fact, colleagues denigrated
such efforts to take extra time. Roxanne continued:
Patients have told me that I’m the only doctor who listened to
them. I’ll ask fellows a question about a patient, and they’ll have to
go back and ask. Patients come here because they’ve seen other
physicians, and have inches of papers of blood work and X-rays
that I don’t look at. But get a detailed history, and the patient will
tell you their diagnosis. They’ll say, ‘‘I get pain that comes after I
eat,’’ and diagnose their ulcer. Other doctors have not had the
time. Everything is driven by efficiency now. If a fellow is slow, it’s
seen as bad, even if it’s because he’s taking more time with patients.
Consequently, as a result of these pressures, as antidotes some phy-
sicians developed special approaches or mechanisms for giving more time
to patients—often revisiting and speaking to them at other times than
while on rounds. Deborah, the psychiatrist with cancer, said:
A nurse told me, ‘‘You have a special way of talking to patients.
You come back—you don’t just leave them, or not show up. You
listen.’’ I didn’t want to say, ‘‘It’s because I am a patient, what do
you expect?’’ I really feel compassion. I can’t explain it. Sometimes
I check on patients when the other interns aren’t here, because I
think patients talk to me much more honestly than with a whole
group.
As Deborah said, doctors often talked with patients only on group
rounds, which can discourage thorough or optimal communication. Yet
she indicated, too, that she can’t wholly describe the difference she now
felt—the heightened empathy. No doubt, this interaction involved emo-
tional, not just intellectual, connections, and can be subtle and nonverbal.
Many physicians now offered more information to their patients. These
doctors may explicitly share their uncertainties more, or check if patients
have additional questions. As a result of being a patient, Roger, the HIV-
infected surgeon who became suicidal, divulged more than before his
clinical reasoning to those he treated.
I’m much more likely to explain why I’m doing things. Other
physicians make decisions, but don’t say what they’re thinking
about to patients. . . . I give . . . my rationale, doubts: ‘‘Basically, this