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"Do you know why we never see my husband's urologist anymore?" A patient's wife asked one day.

"No, tell me."

"After Frank (her husband) had his biopsies done, the urologist called on the phone and I answered. He said to me, 'Would you please do me a favor and tell your husband that he has prostate cancer?'"

The story reminded me of a time when I (Timothy Gilligan) was a fellow and was rounding on the patient of a famous oncologist. The oncologist wasn't with me that day, and the patient asked me, "Where's Dr. Doubt It?"

I was puzzled. "Who is Dr. Doubt It?" I asked. "You know," the patient replied, "Dr.________," and he named the famous oncologist.

"Why do you call him Dr. Doubt It?" I asked.

"Because," the patient replied, "when I asked him if he thought I'd still be alive in a year, he said, 'I doubt it.' "

And then there was the day my wife, a cardiologist, called very upset because of the way a surgeon had spoken to her. He had asked her to perform a study on a patient to confirm a finding that radiology had reported and that he doubted. It took a couple of hours to get the test done, and it revealed that the radiology report was incorrect and that, therefore, the patient could undergo an operation that had been planned for earlier that morning.

"You f*#@ing f*#@," the surgeon screamed, "Why did it take so f*#@ing long? Now I'm going to be stuck in the f*#@ing O.R. until midnight!"

In the prior chapter, you read about how difficult caregiving can be for patients in their darkest moments and the impact that can have on clinicians. Sometimes, physicians respond to these challenges by building resilience and effective coping skills. Other times, it brings out the worst in us. One of the challenges we faced teaching a standardized full-day communication skills course was to be responsive to the needs and skill levels of individual clinicians. By making the course highly learner-centered, we could meet the vast majority of learners at a level that was relevant and challenging for them. For some clinicians, however, a full-day course conducted away from the setting in which they practiced was inadequate. With our team leading a new push to train clinicians to communicate more effectively, it was natural that colleagues would ask how we could help with physicians and others who needed more individualized attention. These clinicians were outliers with regard to communication skills or were getting into trouble because of recurrent problems related to interpersonal interactions. What, we were asked, could be done about clinicians who:

  • Told a patient sitting on an exam table in her underwear that she was fat

  • Antagonized colleagues to the point that they wanted to leave ...

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