BEDSIDE MANNERS
The Art of Practicing Medicine
W. Hugh Spruell, M.D.
W. Hugh Spruell, MD
Copyright W. Hugh Spruell 20110
Published by The Center for Self-Actualization, Inc.
Publishing at Smashwords
Published by The Center for Self-Actualization, Inc.
Publishing Division
P.O. Box 98466
Atlanta, Georgia 30359
www.selfactualized.org
Copyright © 2011 by W. Hugh Spruell, MD
Cover Designed by Graphic Gallery, Atlanta, Georgia
Library of Congress Cataloging in Publication Data
Spruell, Hugh W.
Bedside Manner: The Art of Practicing Medicine
ISBN 978-0-9846266-7-0
Without limiting the rights under copyright reserved above, no part of this publication may be reproduced, stored in a retrieval system, or transmitted by any means (electronic, mechanical, photocopying, recording, or otherwise) without written permission from the author. All Rights Reserved.
Printed in the United States of America
About the Author
William Hugh Spruell, Jr., was born in Memphis, Tennessee, and raised in Russellville, Alabama. He graduated from the University of Tennessee with a degree in medicine. He accepted a commission as Captain in the United States Air Force to train in aerospace medicine, receiving an Outstanding Service Award.
Hugh completed his residency in medicine and his fellowship in rheumatology at Emory University, where he was Chief Resident and Instructor in Medicine. Hugh has been board certified in medicine and rheumatology for over thirty-five years. He founded a private practice in internal medicine and rheumatology in 1972, and is still practicing today.
In 1974, Hugh accepted an ongoing appointment as Medical Director of Agnes Scott College. He has actively supported the Arthritis Foundation for thirty-five years. An active Methodist, for the past twenty years, Hugh has been Medical Director of Honduras Outreach, traveling to Honduras twice annually to minister to and treat poverty-stricken families in Central America. Hugh and his wife Nancy have supported several students from Honduras, sending them to universities and nursing and medical schools.
In 2007, he received the Julius McCurdy Citizenship Award from the DeKalb Medical Society. Author of several medical treatises, Hugh has also published a collection of poetry and a remembrance book about his youngest son, Brian. Hugh and his wife Nancy reside in Lilburn, Georgia. They boast about their five children, six grandchildren—and counting.
Acknowledgements
Thanks to my patients who taught me good bedside manners. Thanks to my father who showed me at an early age how to interact with patients. Thanks to Vanessa Sandidge who typed the manuscript for me. Thanks to my son, Blue, who helped with editing and gave me suggestions as I wrote this book, and my nephew Charlie Mason, who drew the cartoons in this book.
Finally, thanks to The Center for Self-Actualization, Inc. and my publisher Deena Jones who has guided me through this and previous books, and my editor Pam Ryan, whose editing suggestions show heart and soul and add greatness to my writing.
Dedication
This book is dedicated to my father, Dr. William Hugh Spruell, Sr. who died at the young age of forty-two in 1951. Because of his caring way, he continues to be remembered as a wonderful doctor by patients who, even to this day, sixty years after his untimely death, comment on his extraordinary bedside manner.
Foreword
My father was a small town physician in Russellville, Alabama. He had the best bedside manner of any physician I have ever known in all my years of practice. I made many house calls with him back when house calls were common. I observed his caring ways and his impeccable patient interaction.
He would quickly change his mood or behavior to meet the emotional needs of his patients as the situation dictated. He was truly the epitome of appropriate bedside manners. I knew his manners worked well because of the enormous number of patients that I met who loved him and often expressed to me how caring and gentle he was.
He died at age forty-two, but even to this day, I meet people who talk of him fifty years after he is gone. As promised in the Hippocratic Oath, my father was respected while he lived and “remembered with affection thereafter”.
I had always wanted to be a doctor, but I had never actually voiced it. I remember distinctly the first time I ever said the words; I was around eight at the time. My father and I were walking along Main Street in Russellville, Alabama one Saturday afternoon and a man approached us. He and my father obviously knew each other and they carried on a brief conversation, to which I paid no attention. When they were about to part, the man turned to me and said, “Hey, little Hugh. How are you doing?”
I replied, and then he asked me, “Hugh, what are you going to be when you grow up?”
Without hesitation I said, “I’m going to be a doctor like my dad.”
I glanced at my father. I could see that he was taken back a bit. I had never voiced that sentiment before and he had never forced the issue. Certainly, at eight years old most kids had no clear idea of what they wanted to do in life. I could tell my dad was proud, and he looked at the other man and smiled.
From that point on, there was never a doubt in my mind that a physician was what I wanted to be. It made it a lot easier for me because every course I took, every school I attended, and every decision I made was based on the ultimate goal of becoming a doctor.
When I would ask my children or students I met, “What do you want to be in life?” they would often reply, “I’m not really sure.” It was more difficult for them, because they did not know what courses to take, what college to attend, or what curriculum they should follow.
My oldest son, Blue, did not decide to be a lawyer until he was in his late thirties, and my daughter, Alexie, did not decide to be a veterinarian until her early thirties.
I remember an article in the Atlanta Journal years ago, written by the president of the Atlanta Medical Society at that time. He said whenever a young person asks if they should pursue medicine as a career, he would reply, “Not really. You should look for something else to do.”
However, if the young person said, “I am going to be a doctor and nothing will stop me,” the president would reply, “That’s wonderful. It’s the greatest thing in the world to do. How can I help?”
I imagine, considering the complexity of the field, the long years of study, not to mention the socio-political concerns about the future of healthcare, the president meant that medicine is not a profession to pursue unless the individual is determined to pursue it. I have always felt the same way. I think to myself that I am glad I chose this profession but then an idea came to me that it may have chosen me or actually God may have directed me to that path. In any case it certainly has been a good fit for me, and I hope for all my patients. I have never wanted to be anything else.
Early in my practice, I was fortunate to realize that the most important aspect of the practice is the manner in which a physician interacts with his or her patient. After forty years of experience, I am convinced it is a fact. Of course, knowledge of medicine and continual education are also paramount to good practice. However, if one does not emanate a good manner to gain the confidence of and make a connection with patients, the ultimate outcome of care can be significantly hindered.
In addition, without connection and meaningful interaction with patients, a physician misses the deepest enjoyment of practicing medicine. For me, a good day is when a patient says to me, “I just feel better when I come to see you,” or “Talking to you makes me feel better.” Then I am assured that my bedside manner was right for that patient, and I consider that day a success.
Good bedside manner comes naturally to some, yet is difficult for others. However, it can be learned like anything else. As we learn in medical school the complicated ins and outs of disease, we can also learn bedside manner. It should be a required part of our medical training.
In a sense, we physicians actually took an oath to practice good bedside manner, as the Hippocratic Oath states: “I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.”
In a world of managed care, technology, and governmental control of medicine and healthcare, our profession is beset by an ever-increasing trend toward depersonalization. It behooves a physician to hold on to the one aspect over which he still has control—the exceptional way he/she cares for, communicates with, and interacts with his/her patients.
Chapter 1
The Oath of Medicine
I swear to fulfill, to the best of my ability and judgment, this covenant:
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will not be ashamed to say, “I know not.” Nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given to me to save a life, all thanks. But it may also be within my power to take a life: this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.
I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.
I will prevent disease whenever I can, for prevention is preferable to cure.
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.
If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.
—Hippocratic Oath, Modern Version
The Hippocratic Oath has been used for hundreds of years as the standard oath of physicians as they pass from students to medical doctors. Some scholars actually believe Pythagoras proposed the oath, although it is more widely attributed to Hippocrates around 400 or 500 BC. Through the years, the form has been rewritten, but the basic tenets remain the same. I chose to use the modern version for this book. Dr. Lewis Lasanga, dean of the School of Medicine at Tufts University, proposed this version in 1964.
While it is assumed to be a requirement that all American physicians take the oath on graduation, some schools do not require it. Whether required of recent graduates of medicine or not, it certainly should be the way a physician approaches patients in the healing endeavor.
Most physicians swore this oath upon becoming a physician, and I must admit I have probably not reread the oath more than two to three times since I took it forty-six years ago. Its admonishments include the words “judgment”, “respect”, “warmth”, “sympathy”, “understanding”, “responsibility”, and “obligation”. Considering the oath while writing this book, I have come to a greater appreciation of what an awesome responsibility I have being a physician, if I am to uphold the tenets of the oath.
It would appear on the surface that simple diagnosis and treatment is the most important responsibility of a physician. Actually, in looking more deeply, caring and empathy, as well as understanding a patient comes first, then diagnosis and treatment follow more easily and more completely.
Years ago the term “bedside manner” applied almost exclusively to the physician and the patient’s perceived interaction with them. More often than not, physicians treated patients in a home setting and often at the bedside, especially if the patients were seriously ill. House calls were common. I am reminded of a picture of a physician at the bedside of his patient, his face reflecting his concern as he contemplated the answer to his patient’s problem.
Nowadays the term “bedside manner” applies to a physician’s attitude, as he evaluates patients no matter where the setting or location happens to be. The term has broadened to include any healthcare giver, including chiropractors, nurses, physician assistants, nurse practitioners, therapists, and medical assistants. In fact, it includes anyone who cares for another individual in a healthcare setting.
Good bedside manner implies a caring, interested, listening attitude in keeping with the individual’s needs. It is mostly a one-way activity regardless of the response of the recipient, although their attitude may modify how the healthcare giver acts in order to obtain an optimum response from the patient.
The ultimate purpose of a good bedside manner is to put a patient at ease to aid in the return of their most favorable mental and physical wellbeing. So many components contribute to the sum of good bedside manner that we must consider each part separately to understand the whole.
Chapter 2
The Practice of Medicine
I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.
As a physician, one needs to continually seek to learn. Fortunately, continuing education is a requirement for renewing one’s license in most areas of the world. Advanced technology has made learning and staying abreast of developments in the medical field far easier and more efficient today. We are fortunate to be able to stand on the shoulders of many great medical minds that have blazed the way for us. When patting ourselves on the back for the professional skills that we have developed through years of dedication and training, we must also be respectful, humble and grateful for the knowledge available to us through years of other’s endeavors. Physicians should feel blessed that they have been gifted with the ability to practice medicine.
Sharing our knowledge with others is of utmost importance as well. Being alert for any small or large examination or laboratory test finding may advance the state of diagnosis and treatment. The medical community at large might not be aware of such a finding, so sharing it may be helpful in the care of other patients.
Years ago my partner, Gary, noted that a simple wrist withdrawal sign upon flexion of the wrist indicated a small amount of synovitis when simple observation and palpation might not suggest swelling. I have found this exam most useful in diagnosing patients with rheumatoid arthritis.
My father was always searching for ways to improve upon standard methods of medical technique. He was more than willing to share his knowledge with others, and often accepted medical students from the University of Tennessee, allowing them to spend time with him to augment their studies.
In the brief period that my father practiced medicine, he gave back to the community in myriad ways. I did not discover until years later that he had financially supported a number of nursing and medical students who were having difficulty paying for their training. More than one of my father’s friends later shared with me that he was always ready to help those who could not afford schooling for the healthcare field. Physicians have a responsibility to give back to the community and to any individual who may wish wishes to carry on this great human endeavor.