The Importance of Bedside Manner

The Importance of Bedside Manner

My best friend assigned me power of attorney for all health care decisions. My friend is fighting a stage-four cancer. Watching him battle the effects of chemotherapy, radiation, and cancer is heartrending. Seeing what cancer can do, loss of weight, pain riddling his body, and the dimming of his spirit, is excruciating. I recently experienced another unpleasant side effect of cancer: becoming a health care surrogate.

One Friday evening his body was wracked with convulsions, his skin was a waxy gray, perspiration dotted his forehead, and he vomited. I rushed him to the emergency room. Controlled chaos ensued. Intravenous drips were started, a full scan of symptoms and test results were reviewed within minutes. Questions were flying regarding the manifestation of his current state. I was answering for him because he was no longer conscious. Then a nurse turned to me and asked if he had an Advance Directive or Living Will. She followed up with inquiries regarding care in case his heart stops, he isn’t breathing, etc.

Early the next morning I reviewed his Living Will to safeguard his wishes and establish what I knew he wanted. The document outlined as many scenarios as possible. A Living Will is not infallible. It cannot take into consideration all of the medical events which may occur but his was thorough. I felt confident acting as his representative.

Walking into his room and seeing him, a small figure cloaked in crisp white sheets, renewed my resolve to communicate his intentions properly. The resident came in the room asked about his Living Will. When she was given the document, she quickly dismissed it. Instead of reviewing the document she began to explain how Living Wills were pointless because they didn’t tell the medical team what the patient would want. She asked me several times what he would want in certain cases and I replied several times with the same answers. After each response she patronized me, slowly explaining each medical situation and the response the medical team would give.

Finally, I snapped. I had been asked and I answered several times what his preferences were and I did not appreciate her approach. She didn’t blink, in fact, she never looked at me during the entire exchange. Her lack of bedside manner and patronizing way of discussing his Living Will left me concerned about what would happen if he did have a cardiac incident or slipped into a coma. Would his Living Will be honored? Would I be consulted?

The importance of communication was not lost on me during this incident. I understood the resident’s concern that I may not fully understand the medical procedure and what terms encompassed. However, I also made it clear several times I comprehended the scope of medical obligation as well as my friend's legal decisions. The resident’s patronizing way combined with her dismissal of a legal document unsettled me. Instead of talking down to me and rejecting my friend’s Living Will she may have taken a more productive approach: sitting down next to me instead of standing over me, asking if I had any questions, and going over the Living Will with me to make sure I understood. All of these things  would have created a productive dialogue. A chance to speak with a caregiver or a patient is an opportunity to create trust and strengthen a bond. She lost this opportunity, my respect, and my trust.

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