Many medical schools are now teaching doctors how to treat patients


August 27, 1991|By Alyssa Gabbay

Near the beginning of "The Doctor," heart surgeon Jack MacKee visits a patient who tried to commit suicide by throwing himself out a fifth floor window. When the patient confesses to feeling ashamed and stupid, Dr. MacKee quips, "You want my advice, next time you want to give yourself some real punishment, try golf. There's no greater torture."

It's a moment that's meant to expose the surgeon's supreme insensitivity, a quality he miraculously sheds after undergoing a bout with laryngeal cancer.

But it's also a scene that makes real doctors bristle -- even as many admit that the movie, which stars William Hurt, conveys an important message in implying that medicine needs an injection of compassion.

"These days, when we're focusing on the high-tech aspects of science, you'd like to think that we're not losing sight of the fact that every patient is a human being, and has feelings," said Dr. Charles Yeo, an associate professor of surgery at the Johns Hopkins University School of Medicine and a general surgeon.

Concern over how doctors treat patients certainly didn't spring up overnight with the release of "The Doctor" on Aug. 16. Appropriate bedside behavior is a growing issue within the medical community, and steps are being taken to address it in medical schools, at hospitals and among physicians, said M. Roy Schwarz, senior vice president of the American Medical Association.

Back in the early 1970s, the American Hospital Association responded to consumer lobbying by forming an organization of patient representatives: Now, 62 percent of American hospitals have at least one person on staff to act as a liaison between patients and hospital staff.

And the AMA just launched a $1.75 million advertising campaign depicting doctors doing community service, with battered women, people with AIDS and others -- aimed at changing the public's perception of doctors.

But it's hard to measure how much these efforts have affected individual doctors. Sara Lee Jacobson, a patient representative at Sinai Hospital since 1976, says there has been no change in the number of complaints she has received about doctors over the past 10 years.

And Baltimore neurosurgeon Ronald Cohen adds, "You can't instill compassion in someone who doesn't have it."

Many believe the best time to influence future doctors is while they're in medical school, and these institutions increasingly are offering or requiring classes in medical ethics and seminars in clinical skills.

Five years ago, Dr. Stephen Brunton, at Long Beach (Calif.) Memorial Medical Center, founded a program where new residents undergo their first day at the hospital as a patient. He hopes it will "give them insight into how the patients feel when they come into the hospital."

Many schools, including Hopkins, now admit students with non-science backgrounds based on the idea that these people may add an element of humanism to doctoring.

And many have been changing curricula to place greater emphasis on doctor-patient relations, according to Louis Kettel, vice president for academic affairs at the Association of American Medical Colleges.

Student-patient interaction now begins early in the medical education at many schools, rather than in the latter half, as was traditional.

For example, the University of Arizona's medical school has instituted a program where first-year students examine "professional" patients -- patients hired by the school to teach the students -- and then are evaluated by those patients using various criteria, including attentiveness, politeness and positive reinforcement.

Locally, medical schools at the University of Maryland and Hopkins require students to take classes in medical ethics and in clinical skills, both of which attempt to teach students how to deal with patients effectively and compassionately.

The University of Maryland School of Medicine also offers its first-year students an optional three-day retreat in which students and faculty discuss the human aspects of medicine, according to Murray Kappelman, the school's associate dean for medical education.

When Hopkins students do clerkships at Francis Scott Key Medical Center, they participate in weekly sessions designed to improve their patient-relationship skills, according to Dr. Philip Zieve, chief of medicine at the center and program founder.

Doctors themselves cite reasons why they can't always act like Marcus Welby, M.D. For one, they point to the long hours worked by many physicians -- particularly residents.

"When you have so many patients, and so much to get done, something has to give," said David Bernard, a third-year pediatrics resident at Johns Hopkins Hospital. "Often, it's the few extra minutes to play a comforting role with a patient."

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