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Bedside manners

are about more than PC counselling skills, says Dr Thurstan Brewin

Communication between doctor and patient matters a great deal because, as a French physician once said, il n'y a pas de maladies, il n'y a que de malades - there are no illnesses, there are only ill people. Any consultation must be two-way. I have (nearly) always been interested to listen to patients and relatives and happy to talk to them. But that does not mean that a doctor or nurse always needs to spend a lot of time on it. Sometimes you do, sometimes you don't.

Too much of the currently fashionable probing and counselling after shock or stress may not only waste precious time - it may actually delay recovery. It is a mistake to think that the amount of time spent must be proportional to how serious or tragic the situation. Good communication is a matter of quality, not just quantity. The greater the tragedy or stress, the greater the risk that time is being wasted, because the person is not listening or cannot absorb a lot of detail.

In my view, what needs to be taught and practised is not just the politically correct art of prolonged listening and counselling, important though that can sometimes be, but the art of high-quality, concise communication that is sincere, accurate, well expressed and tailored to individual needs. Hippocrates considered that brevity in a physician was a virtue. In our present society it seems to be regarded almost as a crime. As with any occupation, brevity helps all the other work waiting to be done. The more time a surgeon, for example, spends talking and listening, the less time he has for operating, so his waiting list grows.

Everybody will agree with being friendly, understanding and interested, but much more controversial is firm leadership. If ever there was a case for using the cliché about throwing the baby out with the bath water, this is it. Due to a desire to get rid of all personal authority and leadership (and all paternalism, however sensitive and caring), some vulnerable and frightened patients are not getting the protection and support that they need. The sooner the pendulum swings back a little the better.

Sometimes we badly need firm decisions from somebody with the confidence and authority of the captain of the ship or the hospital ward sister - people who felt personally responsible and accountable, even when (shock horror) giving orders. As with many situations, advice and decisions about treatment may be difficult because of gaps in information or because the pros and cons of the decisions are so evenly balanced. When things look really bad, what we used to call wise decisions will at least make a better job of damage limitation.

In the medical field, anybody brave enough to stand up to the onslaught of the politically correct is liable to have thrown at them the stale jibe - 'so you think the doctor always knows best?'. You might as well apply this to everybody offering a service to the community. When a plumber with a good reputation comes to my house, I would be foolish not to accept that he knows best. But I have seen it seriously proposed that the doctor should consider even a newborn baby he is looking after as his 'partner'. This is whimsical claptrap. Are we not allowed to do our best for others without having to call them partners? The last thing my plumber needs is me as his partner.

Reproduced from LM issue 121, June 1999

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