Robert A. Buckman, M.D., Ph.D.
Adjunct professor, Behavioral Science
The University of Texas M. D. Anderson Cancer Center
Dr. Buckman: Now here's another situation that may actually be more common, but it's still quite awkward for most of us and rather uncomfortable, that is when the patient is feeling angry. In this scenario, the patient is angry. When the patient comes into the room the doctor has no idea what started the anger off. During the scenario, you're going to see how each time it's used, an empathic response stops the interview from escalating and turning into a shouting match and how it is possible to use an empathic response instead of a direct factual response to the patient's criticisms. It's not necessarily easy to resist the temptation to try and shout the patient down, but it does pay off in the end.
Doctor: Come in me Mr. Davis.
Mr. Davis: Why didn't you tell me about this procedure before it took place?
Doctor: Obviously, you're very upset, tell ...
Mr. Davis: Yes, I'm very upset.
Doctor: Okay, tell me what procedure you're talking about and what...?
Mr. Davis: The Barium Enema that you so kindly prescribed for me. Do you remember that?
Doctor: Yes I do. Tell me what happened, it sounds very bad.
Mr. Davis: It was very painful, it was very humiliating. You think I enjoy going into a clinic where there's an X-ray room where I have things shoved up my ass! You think that's pleasant?
Doctor: I do not and I hear it was very, very unpleasant, obviously. You're obviously really upset. Come and sit down and tell me exactly what happened and how awful it was. Come and sit yourself down.
Mr. Davis: They take me into this X-ray room in a clinic.
Doctor: Yeah.
Mr. Davis: And do this procedure without my knowledge that this was gonna take place. Why didn't you tell me that this was going to take place?
Doctor: Well, well, I have no idea of the pain that was going to be involved in this procedure. Had I been aware of that I obviously would have tried to explore other ways of doing this.
Mr. Davis: Yes.
Doctor: Okay, so it hurts a lot?
Mr. Davis: Absolutely!
Doctor: Didn't I...
Mr. Davis: You have no idea that this procedure causes people pain?
Doctor: It doesn't usually cause a lot of pain. It's always uncomfortable, but obviously some people are much -- have much greater, sort of pain and discomfort.
Mr. Davis: Oh, I just might happen to be one of those people, might I?
Doctor: Of course, of course, of course. Did the pain last just while the procedure was happening or was...?
Mr. Davis: No, it continued quite sometime afterwards when the procedure was over, yes.
Doctor: So, this was of [inaudible].
Mr. Davis: I thought they were going to rip my bowels out.
Doctor: Yeah, ok. I'm sorry to hear that.
Mr. Davis: You're sorry to hear that?
Doctor: Yes I am, yeah.
Mr. Davis: Well, I'm sorry you didn't experience it yourself, so you would know exactly what I was talking about.
Doctor: I understand what you're saying. I mean, I guess the standard piece of information that they give you at the Radiology Department says it's going to be uncomfortable and it's only occasionally that somebody's bowel, as it were, is so sensitive that it really, really hurts a lot. There's no way of predicting who is going to have a rotten time of it.
Mr. Davis: Well, I guess that's why they call it practice, isn't it?
Doctor: I take your point. I take your point. I think it's -- now, even though Mr. Davis it was a horrible experience, I want to separate that from the result of the Barium Enema, because the result is important. Now, although it was a nasty experience, I was worried, when I ordered that, I was worried that your symptoms might have been related to something really serious. I was actually worried that you might have had a cancer in the bowel. I think we discussed that briefly. Now, separating the trauma of the experience from the result of the Barium Enema, I'm really glad to tell you that, actually, there was no cancer in the bowel. You're clear. There is no problem. What you have are those symptoms. The symptoms are what we call Irritable Bowel Syndrome and I'll talk more about it in a moment or two, but even though it's not...
Mr. Davis: Well, I'm glad that the news turned out that way as well, but had I been a little more prepared, this wouldn't be happening at this point in time.
Doctor: I understand you. I understand you to this extent that if ever we need another procedure, whatever, I mean a Barium Enema or Gastroscopy or anything in the future, you must remind me and I'll remind myself. I'll mark it in your chart. I will give you some pills, which you take the night before and on the morning of the procedure, which will make you, sort of almost like a mild anesthetic kind of thing, so...
Mr. Davis: That would have been very helpful.
Doctor: I guess if we had known then what we do now... that it was going to cause this amount of trauma, we would have given you those pills.
Mr. Davis: It's not my way to treat people in your profession this way, but I'm...
Doctor: I understand.
Mr. Davis: This is not acceptable.
Doctor: I understand entirely and I also understand that you don't normally behave like this. You're not normally that cross and what I thought is something really bad must have happened to make you so distressed.
Mr. Davis: Well, I thought it was pretty bad, yes.
Doctor: So, I'm glad that it was that awful experience that led to the result that it did, no cancer.
Mr. Davis: Well, I'm glad about it, as well.
Doctor: And if anything, any procedure is needed in the future, I'll give you some pills.
Mr. Davis: All right.
Doctor: All right.
Mr. Davis: Thank you.
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