Medical Speech Pathology

Curiosity, Dialogue, and Knowledge

Bedside Manner

a bit of urban art depicting a doctor listening to a heart, which is drawn onto a brick wall in the San Francisco Area

photo by Jeremy Brooks

The space between myself and my patients is necessary. When I’m too close to my patients, they don’t listen. They think they can ignore me like they ignore a friend’s unwanted advice. They laugh at my jokes, listen attentively, then go and do the thing I told them not to do. That space, however, is always changing.

The shortest distance between two points is a straight line. The truth is a straight line. I tell my patients the truth; at least as much of the truth as they can bear. It’s what makes them understand what they need to know. The doctor hasn’t told my first patient what acute hepatic encephalopathy is; I tell her that her liver is making her crazy. I don’t say it that bluntly. I say that her filter isn’t filtering everything it should. When some things don’t get filtered it makes it hard to think. I tell her and her family good luck, because I know that attention and memory exercises won’t fix the liver.

My next patient cries. Organ preserving chemo and radiation therapy tend to do that to a person. Organs are preserved, but function is… well, it’s shot. That distance between us shrinks. I hand him a tissue. I express controlled, detached, concern. This is done by retracting the lips tightly, a slow blink of the eye lids, and an easy nod of the head. It shows understanding. Then come the questions: When can I eat again? What’s aspiration pneumonia? Why can’t I drink water? What does dysphagia mean? The short answers are: I don’t know, it’s an infection that can kill you, it’s going into your lungs, and it means trouble swallowing.

A good day is one where there are more smiles than tears.  Sometimes I bring good news.

“Your swallow study shows no aspiration or penetration,” I say. This means they get to eat and drink regular food and drinks. No thickened liquids or pureed hamburgers for you anymore. I smile a little more during these interactions. It’s sincere.

The truth is a straight line. I’m closer to my patients when they are happy. I’m also closer to my patients than I want to be when they are sad.  Sometimes the distance I keep is just a means to sublimate the pain of the shared experience.  But, that pain must be dealt with.  I have to deal with it just like the family does.  As a swallowing therapist (Speech Language Pathologist), I won’t know how close is too close until I meet you, until I learn your circumstances. Then your problems, will in part, become my problems.  I’ll think of you when I’m away from work.  I’ll pray with you if you ask me to.  You are more than a diagnosis.

There is too much clinical detachment. When you try too hard to be detached from the problem, you succeed at only one thing for certain: you lose sight of the person that has the problem.


One comment on “Bedside Manner

  1. Speech pathologists Sydney
    September 1, 2012

    Doctors should have to treat their patient like their own family members nevertheless it need psychological help.

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