Bedside Manner Can’t Be Taught, But It Can Be Learned
Lately, I’ve been thinking a lot about grief. I’m not sure if it’s associated with the particularly gloomy run of cases I’ve seen at the clinic or the personal stress and sadness I’ve recently faced, but something is pulling my emotional barometer towards focusing on the different ways people inwardly, and outwardly, express grief.
I’ve witnessed grief in many different forms. Grief is an emotion shared by all humans, and, if you’re a believer, animals as well. Setting aside observations incurred in my daily activities with friends, family members, and even strangers, and considering only what I see working as a veterinary oncologist, I feel qualified to contemplate this complex topic with a fair share of authority.
Death, illness, disappointment, heartache these are not unfamiliar terms or experiences for me professionally. I recognize this makes me far from unique.
What is particularly distinctive to my perspective as a veterinary oncologist is that I am entrusted to deliver news that will bring grief to other human beings.
The stereotypes of doctors being perceived as compassionate and caring are often equally juxtaposed against those suggesting we are inanimate, cold, and sterile in our delivery of information, especially when it is anything negative or complicated.
The words “bedside manner” are used to describe our ability, or inability as it may be, to perform this exact task. I’m hard-pressed to think of a time when I’ve heard the words used to describe the way we discuss the positives or present favorable news.
I received only very rudimentary grief training during vet school. I possess no formal education in counseling or psychology. I’m not someone considered overly outwardly emotional myself. Like many of my colleagues, I entered the field of veterinary medicine because I relate better to animals than people.
Despite the shortcomings of both my professional training and my personal mental outlook as it relates to grief, my job requires me to be capable of gauging human emotional responses, and to thoughtfully discuss complex topics such as death, palliative care, and hospice. For better or for worse, my education with grief has pretty much solely come from on the job experience.
To this end, I’ve been a quiet observer, watching colleagues speak with owners about issues related to illness, death, and suffering. In this capacity I’ve witnessed ineffective speech, disheartened wording, and dispassionate phrasing.
I’ve also seen colleagues show remarkable empathy, patience, and kindheartedness — even in the face of an owner who literally is taking their grief out on the individuals associated with their pet’s care.
I’ve watched pet owners comfortable with outward manifestations of their sorrow, shedding copious tears, their sadness obvious not only in their facial expressions, but also by their physical actions. Equally as often, I’ve seen those owners who are quiet, preferring to restrict communication to silent glances, nods, or short-worded answers.
When confronted with grief, some owners will ask a tremendous amount of questions, probing for details and explanations of why the terrible event is happening and what can be done to change it. Others are much more accepting, seemingly unconcerned with specifics, focusing more on the moment at hand and how to move on.
What I find the most shocking are those who express their grief through anger. When an angry owner, looking to impart blame as a means to deal with their pain, confronts me in a hostile manner, my faith in all the good aspects of my profession is completely rattled. Of all the emotions I encounter in a given day or week, it’s anger that causes me the most personal anxiety and strain.
It would be wonderful if I always knew the right words to say or the best way to console someone, or if even half the time I felt as though I did an “okay” job calming down an aggressive owner. The truth is, I simply don’t always know the right response. When anger and grief mix, I’m not the person you want playing on your team.
Though I’m a tougher person than I was when I first started working, I’ll never possess thick enough skin to let such events roll off without consideration. When I write about such cases from vet school, or about my early days as an oncology resident, my husband will ask me, “How do you remember these pets?” I answer honestly, “These are the things I can never forget.”
Despite knowing I’d certainly rest a bit better if I could dislodge those memories of angry pet owners from my brain, I’m certain I wouldn’t want to forget them. The fact that I still consider the words and actions of a few select owners this far along in my career keeps me grounded.
Even though I’m far from perfect in my ability to handle aggressive situations when they arise, I’m still capable of feeling something other than resentment towards those who are angered at the news I bring. This is, at least in part, because I can remember those who do the opposite; sharing their sorrow with me because they trust my response.
Those are the one percent we doctors do it for. Their quiet voices are heard as much as the raging ones. Their grief affects me as deeply as those who resort to anger.
My bedside manner indelibly influenced their pain and grief.
Dr. Joanne Intile
Image: Kamira / Shutterstock