has found seven behaviors define the 'ideal' doctor
and supports an Institute of Medicine recommendation that
quality medical care should include a patient-centered approach.
The Mayo Clinic-led study was designed to develop
a comprehensive set of ideal doctor behaviors.
Telephone interviews were conducted in 2001 and 2002 with 192 patients
who were seen in 14 medical specialties of Mayo Clinic
in Scottsdale, Ariz., and Rochester.
Reported in the recent issue of Mayo Clinic Proceedings,
the article was based on transcripts of patients
detailing their best and worst experiences with a Mayo Clinic physician.
From the transcripts, study authors identified seven behaviors that
describe the ideal doctor
-- confident, empathetic, humane, personal,
forthright, respectful and thorough.
Conversely, patients who described a "worst physician"
experience focused on traits reflecting opposites of desired doctor behaviors,
particularly perceived insensitive or disrespectful behavior.
The study suggests that training new and practicing physicians
about interpersonal skills could have far-reaching effects for patients.
The quality of a patient's relationship with a doctor can affect not only a patient's emotional responses,
but also behavioral and medical outcomes
such as compliance and recovery.
An editorial in the same issue expands on the patient-doctor relationship,
saying health institutions ought to follow the recommendations of
the Institute of Medicine to improve quality by
fostering a patient-centeredness approach to medicine.
James Li, M.D., Ph.D., Mayo Clinic Division of Allergic Diseases,
writes in an editorial that health care can't meet a standard of quality if the patient-doctor interaction is hurried, disrespectful, cold or callous.
Dr. Li has been involved with developing programs and curricula
for teaching new and practicing physicians at Mayo Clinic
about how to strengthen their interactions with patients.
Mayo's structure of focusing on the patient also helps
nurture strong relationships between doctor and patient, he says.
"A doctor who pays personal attention to the patient,
who is respectful, compassionate and competent,
that's what every patient wants,"
Dr. Li says.
"It's really the duty and obligation of the medical community
to design a health care system so that
physicians are best able to exhibit those qualities
for the good of the patient during the clinical encounter."
Dr. Li notes the seven behavioral traits identified by scientists
as ideal for physicians can be taught in various settings,
such as having medical residents witness positive interactions
which they can model.
Of the seven behavior traits, "thorough" was named most often by patients.
Patients can sense if a doctor is rushed or preoccupied,
the study's authors say,
just as they can sense a physician's genuine interest.
This ain't a song for the broken-hearted No silent prayer for the faith-departed I ain't gonna be just a face in the crowd You're gonna hear my voice When I shout it out loud
It's my life It's now or never I ain't gonna live forever I just want to live while I'm alive (It's my life) My heart is like an open highway Like Frankie said I did it my way I just wanna live while I'm alive It's my life
This is for the ones who stood their ground For Tommy and Gina who never backed down Tomorrow's getting harder make no mistake Luck ain't even lucky Got to make your own breaks
It's my life And it's now or never I ain't gonna live forever I just want to live while I'm alive (It's my life) My heart is like an open highway Like Frankie said I did it my way I just want to live while I'm alive 'Cause it's my life
Better stand tall when they're calling you out Don't bend, don't break, baby, don't back down
It's my life And it's now or never 'Cause I ain't gonna live forever I just want to live while I'm alive (It's my life) My heart is like an open highway Like Frankie said I did it my way I just want to live while I'm alive 'Cause it's my life!
Kubler-Ross revolutionized the way Americans look at death and dying,
but decades of work with the terminally ill
has done little to ease her own transition into the great beyond.
Two years of medical problems and existential angst
have forced the Swiss-born psychiatrist and spiritualist to question her own legacy and to reconsider her ideas about life, death and "the other side."
"For 15 hours a day, I sit in this same chair, totally dependent on someone else coming in here to make me a cup of tea," she says.
"It's neither living nor dying. It's stuck in the middle."
"My only regret is that for 40 years I spoke of a good God who helps people,
who knows what you need and how all you have to do is ask for it.
Well, that's baloney.I want to tell the world that it's a bunch of bull.
Don't believe a word of it."
"When I came to this country in 1958, to be a dying patient in a medical hospital was a nightmare,"
Kubler-Ross said in an interview at her home last week.
"You were put in the last room,
furthest away from the nurses' station.
You were full of pain, but they wouldn't give you morphine.
Nobody told you that you were full of cancer
and that it was understandable that
you had pain and needed medication.
But the doctors were afraid of making their patients drug addicts.
It was so stupid."
In 1969, Kubler-Ross published "On Death and Dying,"
a trail-blazing book that made her famous
and helped launch the hospice movement in the United States.
"She was the first to break the taboo about death
-- to get physicians and nurses to realize that death is a part of life," said David Kessler, a hospice movement leader and author of the new book
"There is nowhere on Earth now where they don't know
Elisabeth Kubler-Ross and the five stages of death and dying," Kessler said.
According to the Kubler-Ross model,
dying patients often go through five emotional stages
-- denial, anger, bargaining, depression and acceptance.
Just let dying patients express these emotions, she said.
Make doctors listen to their patients
and give them enough medication to control the pain.
Today, Kubler-Ross is not optimistic about her effect
on the American medical establishment.
"Even now, when we have 2,700 hospices in America, 80 percent of our doctors try not to refer patients to hospice,"
she said. "They see death as their failure."
But what really makes Kubler- Ross question her legacy
is her own encounter with medicine in the 1990s
after suffering a major stroke two years ago.
"After teaching doctors and nurses for decades,
I was in the hospital after my stroke, and it was like my work was nonexistent," she said.
"The nurses never came to see their patients.
They would just sit out there in front of their computers."
"I had this frozen arm and incredible pain.
If you blew on my left arm, I would scream.
The nurse told me I was holding my hand in a funny way
-- which is typical of stroke patients -- and she sat on my arm!
I slugged her with my good arm and yelled,
'That hurts like hell!'
She said, 'Oh, you're becoming combative,'
and brought in two fat nurses who tried to sit on it again.
If I had a pistol, I would have shot them."
"When I left the hospital, I was so depressed," she said. "It was like my work for four decades had gone down the drain.
Nobody learned anything. I only had one good nurse in six weeks in the hospital.
It's a disgrace."
Shortly after moving into her new home in the desert outside Scottsdale, Kubler-Ross suffered a major brain stem stroke.
"It's a lousy retirement," she said. "I can't wait to die."
While her current spiritual vision contains more gloom and doom,
Kubler-Ross continues to believe in the afterlife and spirit guides,
whom she affectionately calls "my spooks."
"I only believe in what I see and hear with my own eyes and ears," said Kubler-Ross, who reports two near-death experiences of her own.
As for skeptics who claim these visions are mere hallucinations
caused by a lack of oxygen to the brain,
Kubler-Ross replies, "Let them wait until they experience it themselves."
Until recently, Kubler-Ross said her belief in
reincarnation inspired her opposition to euthanasia.
There are always lessons left to be learned in life, she said.
Today, Kubler-Ross is not so sure. While she still opposes physician-assisted suicide
and has nothing but disdain for Dr. Jack Kervorkian, she has come to see suicide as a legitimate option.
"If it were not for Kervorkian,
I would have done it a long time ago.
I can't stand this Kervorkian," she said.
"When I've had enough of this, I'll do it myself.
I don't give a hoot about the afterlife,
reincarnation or anything. I'm finished, and I'm not coming back."
Kubler-Ross doesn't miss a beat when asked
which of the five stages of death she finds herself in at the moment.