278 Interacting with Their Patients
is a crapshoot. We don’t know what we’re dealing with here. We’ll
take our best shot.’’ A lot of doctors rush out, but I just psycho-
logically fold my hands and listen.
Though sensitive and compulsive in the past, many of these physicians
now found room to follow up with details even more.
Others tried to communicate better by providing information not
only about the content of decisions, but also the process of clinical care—
what to expect from treatment and its course. Tom, whose lover died of
AIDS, wanted to give patients ‘‘a road map’’ to guide expectations. ‘‘With
managed care, it’s even worse, because you have to wend your way
through the system. I say, ‘Don’t expect this doctor to really be a human
being, just expect them to cut out your gallbladder.’ ’’ Brian, the pedia-
trician with hepatitis, also became more proactive with patients.
I’ve always been good at explaining, but I’m more vigilant now
than before, in talking about side effects and what to expect. I say,
‘‘An hour before you get this, the nurse ought to be giving you a
pill. Make sure you get it.’’ You can do that with some, but not all,
patients.
These suggestions—to be proactive and explicit—can benefit other
physicians and their patients as well.
Ill doctors came to realize the importance of both verbal and non-
verbal interactions as well, and the range of such interchanges. For in-
stance, rubbing a patient’s back can help alleviate an existential sense of
aloneness and isolation. Walter, the political activist, said:
Giving a back rub was so incredibly important to me. It was pro-
foundly human—an act of caring. Even with painkillers, there’s
suffering and pain. Those back rubs were . . . somebody affirm[ing]
that I mattered.
Yet, as mentioned in the previous chapter, such heightened sensitivity
toward patients was not always easy. Competing pressures and demands
can overwhelm. For instance, occasionally, in part for personal reasons
(e.g., if she had a long day), even Jessica, who had a ‘‘warm and fuzzy’’
style, still paid little heed to certain patient complaints.
If I am not in a really good mood, I’ve blown off patients’ com-
plaints. I’ll listen, but sometimes when every organ system causes
pain, I can get a little dismissive.