Rx for M.D.s: Be Nice

Medical courses are too concentrated to leave a student much time for learning how to deal with patients as people. To fill this and other gaps in the physician's preparation for practice, Dr. Stanley R. (for Roosevelt) Truman* has put together in The Doctor (Williams & Wilkins; $3) a lot of sound, down-to-earth advice for young men entering the profession.

His first precept for dealing with patients: be nice to them.

The Better Way. "The majority of physicians still give only lip service to the emotional aspects of the problems of the patient," says Dr. Truman, himself a veteran of 17 years of happy and successful general practice in Oakland, Calif. "There are plenty of capable physicians, the need is for physicians who are nice to people."

Part of being nice is being simple. Truman recalls a colleague who told a patient: "You have an area of stringy shadows from your hilar region extending to the base, and I can hear a few crackles in your chest." Says Truman: "Actually, 'Aba-ca-dav-snaba-pooh' would have conveyed as much meaning to the patient [who had a mild bronchopneumonia]."

Truman's better way: "You remember when you had a sore throat how the inside of your throat looked and felt; well, the same sort of condition exists farther down in your chest."

Along with simple explanations, Truman prescribes simple drawings. A swollen, inflamed appendix is easy to sketch on a prescription pad, and so is the operation of cutting it off. "Perhaps," says Truman (no Vesalius), "the less artistic you are the better you can illustrate for the patient."

Pass It On. Especially difficult is the problem of telling parents that a child is seriously ill or incurably defective. Truman remembers a pediatrician who, after treating a child for nine months, bluntly told the mother, "I am sorry to have to tell you this, but your child is a mongolian, a type of mental defective," and then launched at once into summary advice about "custodial care" for the child's lifetime. It took Family Doctor Truman's best bedside manner to stop the mother's hysteria--and a careful course of consultations to convince the parents that the pediatrician was medically right, if humanly wrong.

Dr. Truman, now president of the American Academy of General Practice, got set on the right path when still in the University of California Medical School. Said an examiner: "A patient consults you for an acute attack of diarrhea and cramps. Discuss the diagnosis and treatment." Student Truman "discussed the differential diagnosis and the various therapeutic possibilities, but I never mentioned giving the patient relief from cramps and diarrhea." He was graded "F" (for failure) with the brisk comment: "Very scientific --nature will have cured the disease while you are making the diagnosis. This patient will never call on you again; learn to treat patients while you are treating the disease."

Truman is trying to pass the lesson on.

*No kin to Harry S. (for nothing) Truman.

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