April 22, 2008
BehindTheMedspeak: How would you feel if your doctor started crying in your presence?
Turns out both doctors and patients have sharply conflicting opinions about whether such behavior is appropriate, desirable or out of bounds.
Here's an essay on the subject by Barron H. Lerner, M.D., from today's New York Times Science section.
- At Bedside, Stay Stoic or Display Emotions?
A young doctor sat down with a terminal lung cancer patient and her husband to discuss the woman’s gloomy prognosis. The patient began to cry. Then the doctor did, too.
The scene was undoubtedly moving. But should physicians display this much emotion at the bedside?
For years, medical schools and residency training programs studiously avoided the topic of emotions. Doctors learned the nuts and bolts of cancer and other serious diseases. Yet when it came time to reveal grim diagnoses, they were largely on their own.
These days, all medical schools have some type of education in topics like the physician-patient relationship and breaking bad news. But knowing how to respond to a personal wave of stress or sadness remains a major challenge. Is crying O.K.? How about hugging a patient who starts to cry?
One physician who cautions against excess emotions is Dr. Hiram S. Cody III, acting chief of the breast cancer service at Memorial Sloan-Kettering Cancer Center. Although Dr. Cody emphasizes the need for doctors “to understand, to sympathize, to empathize and to reassure,” he says his job “is not to be emotional and/or cry with my patients.”
There are two reasons for this stance, Dr. Cody tells young physicians on rounds: It is not therapeutic for the patient, and it will cause “emotional burnout” in the doctor.
These beliefs are shared by many other physicians, but some new data suggest that crying in a medical setting is common among young doctors. At a recent meeting of the Society of General Internal Medicine, Dr. Anthony D. Sung of Harvard Medical School and colleagues reported that 69 percent of medical students and 74 percent of interns said they had cried at least once. As might be expected, more than twice as many women cried as men.
In some instances on the wards, the emotions just flow. For example, in the 1988 PBS documentary “Can We Make a Better Doctor?” a Harvard medical student, Jane Liebschutz, sees her patient unexpectedly die during a cardiac bypass operation. She suddenly bursts into tears and wanders away from her colleagues until the chief surgeon, who has witnessed what happened, assures her that her response was natural.
Other physicians may choose to place themselves in emotional situations. Dr. May Hua, an anesthesiology resident at Columbia University Medical Center, recently told me that during her internship, her supervising resident, Dr. Benita Burke, skipped lunch to spend extra time with her cancer patients. They dubbed this time “mental health rounds,” during which they could address issues that were not strictly medical. Many times, Dr. Burke would wind up in tears or giving an embrace.
“I think patients adored Benita,” Dr. Hua said, “both as their doctor and as their friend.”
But even as she admired her colleague, Dr. Hua realized that such public emotion was not for her. “I knew this was something I couldn’t do, because I needed to have a level of detachment to these people.”
I understood exactly what Dr. Hua meant. Whether because of my personality or my being a man, I, too, have never cried in front of a patient.
Dr. Burke says she believes that her crying stems from being “very involved” in her cases, which leads her to “take everything to heart.” In the case of the lung cancer patient, Dr. Burke had been the first physician to inform her that further aggressive treatment was unlikely to help. In other words, the patient was dying.
Dr. Burke said she realized that this level of involvement was uncommon but believed that she could not be any other kind of doctor. “I’ve always been a very emotional person at baseline,” she said.
Dr. Sung’s study concludes with a call for senior doctors to acknowledge and discuss openly the apparent high rates of crying among medical trainees.
Yet while health professionals — not only physicians but also nurses and social workers — may debate among themselves the propriety of emotional displays, what probably matters most is what patients think. Just as different doctors respond differently to sad situations, so do patients and their families. While some might appreciate physical contact or tears, others find such displays to be too “touchy-feely.”
Cancer patients may encounter such situations more than most. One breast cancer survivor, Sharon Rapoport, of Roanoke, Va., said she greatly admired physicians like Dr. Cody, who may appear reserved but communicate their concern through their actions.
But Ms. Rapoport also said she had an extra appreciation for doctors who felt comfortable with outward displays of emotion. “If that means tears,” she said, “bring them on.”
Dr. Barron H. Lerner teaches medicine and public health at Columbia University Medical Center.
Back when I was an anesthesiology resident at UCLA one of my fellow residents, during a preoperative visit with a patient, got down on his knees at the patient's bedside to pray for him.
He was fired the next day.
A few weeks later he joined the residency program across town at Los Angeles County-University of Southern California Medical Center, where things were so bad his indiscretion was either overlooked or disregarded.
There he became a star and eventually chief resident.
Bowl with Integrated Spoon Rest
"Don't you hate it when the spoon handle falls into your food?"
That's how one catalog's copy for this item begins.
But wait a minute — seems to me that I'm clumsy enough to still end up with the handle submerged unless I pay close attention to spoon placement....
"Multifunctional and stackable, these ceramic bowls prevent such accidents and keep used spoons off counters and tabletops."
Designed by Élan Falvai, the ceramic bowl is microwaveable and dishwasher safe.
Stainless steel spoon included.
3" high x 5" diameter.
16 oz. capacity.
Pacific [Blue], Tofu [White] or Black Bean.
An ad you wouldn't have seen — or understood — 30 years ago
Above, today's quarter-page ad in The Financial Times.
"This is your brain on the FT."
I like it.
Lighter Socket LED
Lighter Socket LED
LED light stays charged and ready in your lighter socket
Need a little light?
This compact rechargeable LED light fits unobtrusively in your lighter socket so it's always ready and close at hand.
The 0.5-watt LED is 5 times more powerful than regular LEDs and runs 2 hours on a single charge.
Anodized aluminum body stays out of the way until needed.
My friend Dan Rutter reviewed this item on dansdata.com three weeks ago in his inimitable "thoroughly-is-a-major-understatement" fashion and gave it his "Highly Recommended" seal of approval.
Trust me, that does not happen very often.
No greater praise can a product receive.
Choice of 10 colors: Race Car Red, Hazard Country Orange, Taxi Yellow, Gremlin Green, Lil Mule Blue, Pink Caddy, Pimp Purple, Phantom Silver, Time Machine Titanium, Jet Black.
The end of advertising as we know it
You don't have to have a triple-figure IQ to know that something is happening here, do you, Mr. Jones?
I read with interest Suzanne Vranica's April 17, 2008 Wall Street Journal article headlined "Agency's Work for PepsiCo Fizzles Out" about how Omnicon's Element 79, once the darling of the bleeding edge advertising world for its commercials starring Michael Jordan, Mia Hamm and friends sweating colored Gatorade droplets, has been dumped due to PepsiCo being "... dissatisfied with Element 79's recent creative work...."
Memo to PepsiCo: It isn't the agency that's the problem.
So habituated are all major corporations to the worn-out axioms of 20th century marketing, that all you need to do is create a great commercial and then pound it into the viewer's head like a stake into the ground, over and over and over, repeating the very same commercial not just the same day but within the framework of the same show, sometimes in successive commercials minutes apart, again and again and again, believing the viewer has no choice — or inclination — to do anything other than sit there in a stupor watching it, that the tectonic revolution happening right beneath their feet isn't even registering on their what's happening meters.
We click and leave now when we're bored — or when we know we're about to be.
Why do you think so many people read bookofjoe?
Wait a minute....
Our remotes have mute buttons and can surf beautifully the instant something repetitive and annoying appears.
Even the funniest joke becomes irritating when it's retold ten times a day.
Without further ado, then, joe's 3 Commandments for 21st Century TV Advertising:
1) Thou shalt not repeat a commercial within an hour of its last showing — anywhere in the same time zone.
2) Thou shalt not spend a fortune making any one commercial or series of them, since they're never gonna come remotely close to earning back their cost.
3) Thou shalt therefore realize, o corporations and ad agencies, that the future of your products lies in taking off the tunnel vision blinders and not just looking in different directions but seeing with different eyes. If you can't do that from within, find them outside your corporate confines. Remember that reality goes not just sideways and forward and backward and up and down but moves as well in time. Use the fourth dimension — or it will use and crush you.
Remote Control Pocket Pillow
From the website:
- Remote Control Pocket Pillow
You'll never have to pull apart the couch cushions or search under the magazines on the coffee table ever again.
With this clever and contemporary pillow that features an embroidered labeled pocket for the remote control, you'll always know where your favorite gadget is.
Functional and stylish, this home accent for the modern couch potato is handmade in Michigan by Mary and Shelly Klein from hemp and organic cotton.
Pillow is 18" x 18"; pocket measures 10.25"H x 6.25"W.
Zipper closure for easy removal and cleaning.
Insert is polyester fiber.
Dry clean only.
Black or Natural.
$116 (yeah, sure — remote included. What's wrong with you?).
iComment.com — 'Stick your opinions all over the web!'
I saw the website's little ad in the new issue (May, 2008) of Wired magazine so I had my crack research team investigate.
Long story short: "... turns every web page into a huge discussion board, open forum, chat and social network — post comments right on any web page."
That got me all fired up.
Then came the bad news: "For Internet Explorer and Firefox."
For Mr. Camino here that translates as "game over."
Maybe next year.
You go on ahead without me.
Hoverit Limited Edition Hovering Lounger — 'Don't let gravity get you down!'
Transparent acrylic chair hovers several inches above the floor on a magnetic force field blanket.
Powerful non-electric repelling magnets in the base and seat leave it in permanent float mode.
Two locating rods prevent the seat from sliding off sideways but allow motion up and down.
Hovers in mid-air 24/7 forever, anywhere, without requiring a power source.
Handmade base and chaise-longue-type seat designed by Keith Dixon.
Supports a person weighing up to 266 pounds.
£5,875 ($11,635; €7,325).
Note: "Do not use the lounger if you have a heart pacemaker."
Note #2: "May erase credit cards and cause laptop computer malfunction."