Thank you for this article! I have believed and taught this for many years. I've been a patient more times than I can count without growing more fingers and toes. I've been near death more than once, and my family was once informed that I "probably wouldn't make it" after a logging accident. The only medical person I remember from that experience was an incredible nurse named Sue who held my hand, talked to me, and covered me in warm blankets. She CARED for me while the professionals around her treated the fractures, controlled the bleeding, and ignored ME. In medicine, we have gotten away from treating patients and resorted to treating conditions, heart rhythms, pulse oximetry, etc. We must treat the patient as the human being they are. They are terrified, lonely, and broken. A study many years ago claimed that we could extend our life span by up to 20 years by maintaining a good, positive attitude. This has been proven over time, and there is no doubt about it - actually listening to patients, giving them hope, and treating them the way we would hope to be treated if the best medicine we can offer. We must ignore the financial incentives to perform tests, throw drugs at everything, and keep people sick. Thank you again for the common-sense article and reminding us of God's golden rule - treat others as you want to be treated.
It was lovely to see the paper by Dr Bruce Thomas on the power of a positive consultation described by John Mandrola. Dr Thomas was a valued colleague of mine in Southampton. I did the statistics for this paper and he thanks me for this at the end of the paper. This paper was a 'short communication' to the BMJ and so much detail is missing. The title does not mention it was indeed a randomised trial. Dr Thomas had two piles of shuffled cards in his desk drawer and when he decided the patient was eligible for the trial he secretly open the drawer and took one card to be told whether to treat of not, and another to be told whether to give a positive or negative consultation. It has stood the test of time and has over 650 citations on Google Scholar.
It was a different era nearly 40 years ago! There was no funding-for the research. I received a pot of honey from Dr Thomas' own hives for my work. As far as I know there was no ethics committee approval. There was no prior sample size calculation given although in fact I think I had done one. The method of randomisation is unlikely to be approved of today! However, it was a very influential paper and led to a lot of work in complementary medicine in Southampton and elsewhere.
I've always had the policy that if I don't know the dx, I tell the patient I don't know. But I add that "I care" and "I'll keep trying." I don't want to give a "positive dx" if I don't know the dx. But I can be honest, caring, and let the patient know I'll keep trying
One piece of advice that was frequently helpful for interns and residents was that when you walk into the room to meet a patient, remember that you are on stage and your performance (positive, considerate, attentive, vs grumpy, dismissive, distracted), can greatly influence the patient's perception of your competence and their response to whatever treatment you recommended.
"Hippocratic physicians did not claim to perform miraculous cures. But rather, above all, they strove to do no harm. They presented themselves as faithful friends to the sick” (Porter, 2003).
The placebo effect is real! The mind’s influence over the body is incredible. A kind word or a hopeful outlook from a doctor can make a real difference and put people in a happier state of mind. Great post!
And it reminds me of two of my favorite and sadly departed physicians I've had the privilege of encountering: my old man, Dr Bob Gitchell, and dear colleague and friend, Dr John Slade.
I've put in links to memorial information for those interested.
I also fondly remember the sign that Dr Slade had in his office: "They will not care how much you know until they know how much you care."
I frequently return to the "notes" in Dr Slade's memorial wall as a reminder of how he was trusted and beloved by leaders across the full spectrum of beliefs about the future of tobacco harm minimization. And why I wear a bracelet asking "What Would Slade Do?"
One of my surgical mentors, Dr. Clay Phillips, told us, “The physician’s visit should somehow make the patient better, even if it is just to fluff their pillow”. In a similar vein, studies have shown that patients perceive the physician’s visit to be longer if they sit as opposed to standing despite being the same amount of time.
I was in the ICU for a month due to a bike accident with IV, Pick Line and on a vent. All told my visit was 7 and a half weeks. The most important thing I remember is Docs or nurses just stopping by and patting me on the back and saying by fall this will all be behind you. The human touch and just a few words would make my day. One nurse liked to read and she would stop by and say what should I read about xyz. Just a normal interaction but so powerful. Another time I was taking flying lessons and it was not going well I was on the verge of giving up and my flight instructor said to me "You know I am not going to let you fail" Made a big difference.
I've come to recognize that the very words doctors say can have a huge impact on a patient's condition, mind body connection, and overall course of that condition. I don't think physicians pay enough attention to this.
Certain phrases are just not helpful and can, in fact, be harmful. These are completely unintentional on the doctor's part and are often said as a way to acknowledge and validate the patient's concerns but end up having the opposite effect.
Examples from ways to talk about arthritis: "bone on bone"; "the worst joint I've seen! No wonder you're in pain"
I've had patients live for years or even decades with an inner dread that they carry when a doctor's off the cuff comment sticks in their psyche.
Each specialty will have certain phrases that are just not helpful. Being aware of what those are and having a much more hopeful approach can make a huge difference.
The examples in the "study" done here (from the 1980's as someone pointed out) do sound generally outdated. It really sounds like having a confident-sounding physician vs one that exudes a lack of confidence - it doesn't take a "study" to determine the vast majority of people will respond better to a confident provider (irrespective of diagnosis and treatment plan). There are so many better ways of phrasing the uncertainty involved in diagnosis and treatment. "I can't determine what is wrong with you" and "I'm not certain this will work" sound rather ludicrous- I'd like to see any patient that feels reassured by either phrase! (I certainly wouldn't)
For some patients with certain mindset or personality, an unfailingly upbeat approach can make a world of difference. The art of medicine is being able to match the right approach with each patient as an individual. Listening, true compassion, support, and hope are good for everyone.
I was a night shift charge nurse, just a year out of school, but I still knew the power of suggestion, a friendly unstressed face at 0200. Nighttime is a scary and lonely no matter where you are. The little annoyance during the day is a huge, hovering monster at night. Rather than receive a tired, grouchy doctor's tyraid, I made rounds to my awake patients and gave them their PRN Acetaminophen explaining these tablets will help them relax and take the little aches and pains away. I never lied to my patients and if they had asked I would have told them what I was giving. My patients did rest and finally fall asleep.
A smile, an acknowledgement of a person's concerns whether you can fix it or not, listening, touching makes a huge difference.
On the other hand, I used to see a cheerful upbeat cardiologist who put his post-MI patients on short-acting nifedipine and mexiletine. His patients loved him. Took a lot of work to undo the wrong therapies. I’d rather have a grouchy doctor who got it right.
My concern is, instilling this quality of hope requires speaking in certainties. If I told a patient confidently that their Rx will likely work, and it comes to affect nothing, the patient's trust in me will erode rather quickly. God forbid I tell a client they will probably get better, only to see another clinician later inform them of a new diagnosis of metastatic cancer (am a nurse here).
This is a tough one, oversimplified in this article. I'm an oncology ICU/PACU RN with stage 4 cancer myself. There is incredible pressure on oncology patients to keep hope alive due to it's impact on the disease trajectory. Guilt ensues when there is progression despite doing everything right. We do NOT die from a bad attitude. We die because we are mortal. Stage 4 cancer is not a "battle" and that language sets up patients for failure. I have dealt with this issue professionally and personally, deeply so. My doc's power is in her keen clinical judgment choosing chemotherapy for me to extend my life and keep QOL. Last year I had an extreme reaction to chemo, 16 day hospitalization, septic (rods in blood), WBCs zero, high grade mucositis, desquamation of skin. A few weeks later I checked her notes on my portal "While she has excellent motivation and outlook, her tolerance to chemo is poor" I did really appreciate how she worded that. Thank you for listening to my thoughts.
Thank you for this article! I have believed and taught this for many years. I've been a patient more times than I can count without growing more fingers and toes. I've been near death more than once, and my family was once informed that I "probably wouldn't make it" after a logging accident. The only medical person I remember from that experience was an incredible nurse named Sue who held my hand, talked to me, and covered me in warm blankets. She CARED for me while the professionals around her treated the fractures, controlled the bleeding, and ignored ME. In medicine, we have gotten away from treating patients and resorted to treating conditions, heart rhythms, pulse oximetry, etc. We must treat the patient as the human being they are. They are terrified, lonely, and broken. A study many years ago claimed that we could extend our life span by up to 20 years by maintaining a good, positive attitude. This has been proven over time, and there is no doubt about it - actually listening to patients, giving them hope, and treating them the way we would hope to be treated if the best medicine we can offer. We must ignore the financial incentives to perform tests, throw drugs at everything, and keep people sick. Thank you again for the common-sense article and reminding us of God's golden rule - treat others as you want to be treated.
It was lovely to see the paper by Dr Bruce Thomas on the power of a positive consultation described by John Mandrola. Dr Thomas was a valued colleague of mine in Southampton. I did the statistics for this paper and he thanks me for this at the end of the paper. This paper was a 'short communication' to the BMJ and so much detail is missing. The title does not mention it was indeed a randomised trial. Dr Thomas had two piles of shuffled cards in his desk drawer and when he decided the patient was eligible for the trial he secretly open the drawer and took one card to be told whether to treat of not, and another to be told whether to give a positive or negative consultation. It has stood the test of time and has over 650 citations on Google Scholar.
It was a different era nearly 40 years ago! There was no funding-for the research. I received a pot of honey from Dr Thomas' own hives for my work. As far as I know there was no ethics committee approval. There was no prior sample size calculation given although in fact I think I had done one. The method of randomisation is unlikely to be approved of today! However, it was a very influential paper and led to a lot of work in complementary medicine in Southampton and elsewhere.
Mike Campbell
Emeritus Professor of Medical Statistics
University of Sheffield
I've always had the policy that if I don't know the dx, I tell the patient I don't know. But I add that "I care" and "I'll keep trying." I don't want to give a "positive dx" if I don't know the dx. But I can be honest, caring, and let the patient know I'll keep trying
One piece of advice that was frequently helpful for interns and residents was that when you walk into the room to meet a patient, remember that you are on stage and your performance (positive, considerate, attentive, vs grumpy, dismissive, distracted), can greatly influence the patient's perception of your competence and their response to whatever treatment you recommended.
"Hippocratic physicians did not claim to perform miraculous cures. But rather, above all, they strove to do no harm. They presented themselves as faithful friends to the sick” (Porter, 2003).
The placebo effect is real! The mind’s influence over the body is incredible. A kind word or a hopeful outlook from a doctor can make a real difference and put people in a happier state of mind. Great post!
Thank you--this was so cool.
And it reminds me of two of my favorite and sadly departed physicians I've had the privilege of encountering: my old man, Dr Bob Gitchell, and dear colleague and friend, Dr John Slade.
I've put in links to memorial information for those interested.
I also fondly remember the sign that Dr Slade had in his office: "They will not care how much you know until they know how much you care."
I frequently return to the "notes" in Dr Slade's memorial wall as a reminder of how he was trusted and beloved by leaders across the full spectrum of beliefs about the future of tobacco harm minimization. And why I wear a bracelet asking "What Would Slade Do?"
Joe
https://www.legacy.com/us/obituaries/desmoinesregister/name/robert-gitchell-obituary?id=24501142
http://www.tobaccoprogram.org/index.php?submenu=_about&src=gendocs&ref=JohnSladeMemorialPage&category=_about
Ooops! I should've included my disclosure! I'm sorry!
My employer, Pinney Associates, provides consulting services to Juul Labs on nicotine vapor for tobacco harm minimization.
One of my surgical mentors, Dr. Clay Phillips, told us, “The physician’s visit should somehow make the patient better, even if it is just to fluff their pillow”. In a similar vein, studies have shown that patients perceive the physician’s visit to be longer if they sit as opposed to standing despite being the same amount of time.
I was in the ICU for a month due to a bike accident with IV, Pick Line and on a vent. All told my visit was 7 and a half weeks. The most important thing I remember is Docs or nurses just stopping by and patting me on the back and saying by fall this will all be behind you. The human touch and just a few words would make my day. One nurse liked to read and she would stop by and say what should I read about xyz. Just a normal interaction but so powerful. Another time I was taking flying lessons and it was not going well I was on the verge of giving up and my flight instructor said to me "You know I am not going to let you fail" Made a big difference.
I've come to recognize that the very words doctors say can have a huge impact on a patient's condition, mind body connection, and overall course of that condition. I don't think physicians pay enough attention to this.
Certain phrases are just not helpful and can, in fact, be harmful. These are completely unintentional on the doctor's part and are often said as a way to acknowledge and validate the patient's concerns but end up having the opposite effect.
Examples from ways to talk about arthritis: "bone on bone"; "the worst joint I've seen! No wonder you're in pain"
I've had patients live for years or even decades with an inner dread that they carry when a doctor's off the cuff comment sticks in their psyche.
Each specialty will have certain phrases that are just not helpful. Being aware of what those are and having a much more hopeful approach can make a huge difference.
The examples in the "study" done here (from the 1980's as someone pointed out) do sound generally outdated. It really sounds like having a confident-sounding physician vs one that exudes a lack of confidence - it doesn't take a "study" to determine the vast majority of people will respond better to a confident provider (irrespective of diagnosis and treatment plan). There are so many better ways of phrasing the uncertainty involved in diagnosis and treatment. "I can't determine what is wrong with you" and "I'm not certain this will work" sound rather ludicrous- I'd like to see any patient that feels reassured by either phrase! (I certainly wouldn't)
For some patients with certain mindset or personality, an unfailingly upbeat approach can make a world of difference. The art of medicine is being able to match the right approach with each patient as an individual. Listening, true compassion, support, and hope are good for everyone.
Wonderful doctor … such a good man … making a difference in the lives of his patients. Thank you!
I was a night shift charge nurse, just a year out of school, but I still knew the power of suggestion, a friendly unstressed face at 0200. Nighttime is a scary and lonely no matter where you are. The little annoyance during the day is a huge, hovering monster at night. Rather than receive a tired, grouchy doctor's tyraid, I made rounds to my awake patients and gave them their PRN Acetaminophen explaining these tablets will help them relax and take the little aches and pains away. I never lied to my patients and if they had asked I would have told them what I was giving. My patients did rest and finally fall asleep.
A smile, an acknowledgement of a person's concerns whether you can fix it or not, listening, touching makes a huge difference.
John, your link to the study doesn't go to BMJ. It is a private IP address.
On the other hand, I used to see a cheerful upbeat cardiologist who put his post-MI patients on short-acting nifedipine and mexiletine. His patients loved him. Took a lot of work to undo the wrong therapies. I’d rather have a grouchy doctor who got it right.
The old sawbone story about predictors of medical practice success: “Availability, affability, and ability — in that order.”
My concern is, instilling this quality of hope requires speaking in certainties. If I told a patient confidently that their Rx will likely work, and it comes to affect nothing, the patient's trust in me will erode rather quickly. God forbid I tell a client they will probably get better, only to see another clinician later inform them of a new diagnosis of metastatic cancer (am a nurse here).
This is a tough one, oversimplified in this article. I'm an oncology ICU/PACU RN with stage 4 cancer myself. There is incredible pressure on oncology patients to keep hope alive due to it's impact on the disease trajectory. Guilt ensues when there is progression despite doing everything right. We do NOT die from a bad attitude. We die because we are mortal. Stage 4 cancer is not a "battle" and that language sets up patients for failure. I have dealt with this issue professionally and personally, deeply so. My doc's power is in her keen clinical judgment choosing chemotherapy for me to extend my life and keep QOL. Last year I had an extreme reaction to chemo, 16 day hospitalization, septic (rods in blood), WBCs zero, high grade mucositis, desquamation of skin. A few weeks later I checked her notes on my portal "While she has excellent motivation and outlook, her tolerance to chemo is poor" I did really appreciate how she worded that. Thank you for listening to my thoughts.