There was a time not so long ago when a doctor’s skills extended to what was known as the bedside manner. That was an indication of how comfortable he made his patients and gave them confidence. When I was studying medicine in New York I would see this qualitative and quantitative difference in the doctors around me. Some are crusty and short and have no time but may be brilliant in their performance as surgeons. Others are gentle and make good listeners. Still others establish a rapport by involving the families and sharing the facts with them honestly and without drama. In the daily unfolding of the human drama I discovered that people can take honesty a lot more than we give them credit for and if anything, are upset by being treated like children and patronized. They also do not like being kept in the dark and are often resentful of how support staff sideline them.
Perhaps one of the most vital elements in the practice of medicine is the suspense doctors create in getting results. Granted, there is often a long line and there has to be a waiting period but the bureaucratic approach of coming after ‘x’ days causes so much suspense and through it, tangible tension and even I would say a deterioration in the condition of the patient brought about by the stress of not knowing. And worrying about that.
I am aware that some tests take time to get results but with today’s machinery and state of the art computerized technology a urine or blood test can be basically analysed in minutes so telling someone on a Monday to come next week is unnecessary.
By this argument CT scans, ultrasounds, ECGs, x-rays and MRIs may need a day or two for the complete report to be written and dispatched to the said doctor but surely the patient who has just lain there and been radiated can be given a reassuring remark or two right there pending the final report like don’t see anything to worry about. Imagine how much reduction that would cause in stress levels.
So why does medicine globally delay sharing results and not factor in the negative impact of holding the answers.
I once asked a senior doctor this and he said, while much of it was an increased workload the reason why medicine per se had shifted towards being over cautious was because of fear of legal implications. If we prematurely cheer someone up, he said, and then discover something unpleasant, the shock of that would be far worse. Also, if you are not on duty and another doctor interprets the results differently to you then who is responsible. Because of these reasons and the fact that it is more dangerous to give false hope the baby has been thrown out with the bathwater. Now, even if you are viewing an ultrasound for a stone in the bladder and can see it makes no sense telling the patient to come on Monday because we are closed tomorrow.