一個醫生的自白:
When I started my internship, in 1986, I was given a beeper, which was handed over with a certain sense of ceremony and a certain yoke of obligation. Before cellphones were omnipresent, the beeper was a badge of professional importance: I’m a doctor — life and death depend on my instant availability.
If you were talking to a patient and your beeper went off, it was understood to be a medical summons; you were entitled — and expected — to step out of the room and answer. As I went through residency and began practicing, I would never have thought of silencing my beeper when I was seeing a patient, even though I was often paged about things that were not of immediate life-or-death importance. (“Mom, I couldn’t find my social studies project this morning. Did you put it somewhere?”)
Nowadays, every patient I see is just as reachable in the exam room as I am, and my reactions to their behavior with their cellphones has made me question my own attitudes toward monitoring messages and tolerating interruptions.
I asked Judith Martin, who writes the Miss Manners books and columns, what the etiquette considerations are here, and she let me know in no uncertain terms that doctors themselves traded on their greater prestige in the doctor-patient relationship to create a culture that allowed rudeness — and that rudeness is now being returned.
“We are reaping the punishment of doctors having used these manners when patients could not,” she said.
It’s not just doctors, of course; it’s a problem outside medical settings as well, she said, with “people keeping one another waiting, ignoring those who are present in favor of taking phone calls.” Now everyone has the equivalent of a beeper, and everyone answers because, after all, it might be an emergency.
In the exam room, patients routinely take calls, or at least glance at their phones. And adolescents, needless to say, can go on texting even as they’re answering a doctor’s questions.
Manners, morals and medicine intersect in the doctor’s office, in a quotidian interplay of patient imperatives and medical management, politeness and professionalism, patients and patience.
What are the ethics of keeping one another waiting?
“These issues are hugely important to patient satisfaction, to patient compliance, to patient trust, and to physician peace of mind, or a physician’s positive attitude about work and environment,” said Arthur L. Caplan, director of the bioethics division at NYU Langone Medical Center. “But ethicists spend almost no time thinking about them.”
I am not a particularly patient patient, and recently, when I went with my mother to the eye doctor, I found myself getting pretty cranky in the waiting room. After all, we had made the first morning appointment, gotten ourselves out of bed and out into the cold and across town for a 7:30 time slot.
Was it possible, I wondered irritably, that the doctor hadn’t even arrived yet? And I went back to the clinic desk to ask once again, in a polite but clearly provocative way, if they knew how much longer it would be.
But here is my confession: That agonizing sense of the minutes ticking past, that outraged feeling of cosmic unfairness when an early appointment is not matched by a prompt consummation, it all falls away when I’m on the other side of that clinic desk.
Later that very same day, getting ready for my next patient, it made complete sense to me that first I had to read through the child’s medical record on screen — and then, yes, check my messages quickly, and then stand in the hallway and speak to a colleague for a little while — all with the patient and her mother (and the next patient and his mother) sitting in the waiting room and, well, waiting.
And keeping children waiting is even more inexcusable than keeping adults waiting; children are not suited for waiting.
The truth is, I was in the doctor’s time zone. And I had a feeling of hard-working entitlement that coexisted remarkably easily with the very recent memory of my own sense of outrage at being made to wait.
Later that day, while I was asking a 10-year-old girl some questions about her health, her mother’s cellphone rang, with one of those loud, intrusive musical ringtones. I was neither surprised nor outraged when the mother reached into her bag, pulled out the phone and started chatting. But I suspended my conversation with the child and stared questioningly at the mother until she said, “I can’t talk now, we’re with the doctor,” and hung up.
But the calls to my phone, as important as they may be to me, are not actually life-or-death patient issues, and I, too, need to turn it off.
Dr. Caplan pointed out that part of providing good and professional medical care is treating people properly: “How do I cement trust in this relationship? How do we show respect for one another in a health care relationship where respect is partially an intrinsic good but also important for securing cooperation, compliance, continuity of care?”
Sometimes cementing trust and showing respect actually means sitting quietly while a parent takes a phone call and arranges, for example, the pickup that will get her home after that too-long wait in the exam room. Good manners, and good morals, actually depend on getting outside the doctor’s time zone and crossing over to where everyone else lives.
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