Bedside Manner and the Pendulum Effect

David Mendel’s book “Proper Doctoring”, published in 1984, the year I finished my residency training, just came out in a new edition, seven years after his death. Born in London in 1922, his words very much sound like those of the generation before me, but they are somehow also timeless and as relevant today as they were thirty years ago.

On the topic of bedside manner, he writes:

“One absolutely essential ingredient of proper doctoring us the much-maligned bedside manner. The best doctors acquire one over the years, but many never do. I think that this is due to the usual overswing of the pendulum. Around the turn of the century, medical remedies were not very effective; in the circumstances the bedside manner was all there was. Now that we can cure many diseases, both doctors and the public have replaced the wise avuncular physician of the past with the ’intensive care whizz-kid’ image. We don’t need all that mumbo-jumbo when we have proper scientific methods, they say.”

Indeed, a physician from the generation before Mendel, Swedish-born Axel Munthe, writes about his days as a popular young doctor in Paris in his 1929 memoir, “The Story of San Michele”. At the time there were some very successful doctors in Paris, who had the reputation of being quacks, with fake diplomas but with charming bedside manners. They were all called to the police precinct to have their credentials examined. The most successful one showed up at the last minute and requested a private meeting with the Commisaire. He implored the official to keep his diploma from a prestigious German university secret, as he felt he owed his financial success to his reputation of being a quack.

Today, eighty-five years after Munthe’s best seller and thirty years after Mendel’s book, the pendulum has yet to turn back. The caring 1970’s family doctor, Marcus Welby, has given up his spot to “House”, whose brilliance excuses his personality deficiencies.

Mendel describes science as one of four legs on “the medical couch”. The other three are wisdom, experience and caring.

William Osler, by many viewed as the father of modern medicine in North America, in an anecdote retold by author and physician Larry Dossey, exemplified good bedside manner:

“After revolutionizing how medicine was taught and practiced in the United States and Canada, in 1905, at the peak of his fame, he was lured to England where he became the Regius Professor of Medicine at Oxford. One day he went to a graduation ceremony at Oxford, wearing the impressive academic robes that are a feature of the occasion. On the way he stopped by the home of his friend and colleague, Ernest Mallam.

One of Mallam’s young sons was desperately sick with whooping cough. The child would not respond to the ministrations of his parents or nurses and appeared to be dying. Osler loved children greatly and had a special way with them. He would often play with them, and children would invariably admit him into their world. So when Osler appeared in his dramatic ceremonial robes, the little boy was captivated. Never had he seen a human like this! After a brief examination Osler sat by the bed, peeled a peach, cut and sugared it, and fed it bit by bit to the enthralled, speechless boy. It was his first nourishment in days. Although recovery was unlikely, Osler returned for the next 40 days, each time dressed in his magnificent robes, and personally fed the child. Within a few days the tide had turned and the little boy’s recovery was assured.”

Larry Dossey goes on to say:

“Compassion is not antiquated. It remains a crucial factor in healing and will never go out of style. It is always available for any healthcare professional who is wise enough to claim it.”

Bedside manner is sometimes now included in medical school curricula, but ultimately it is probably better inspired than taught. If we as physicians give more thought to the roots of our profession, or “proper doctoring”, we will be less distracted by the technical aspects of our work, and more likely to see our patients and their suffering as the real and only reason we entered our profession.

And may the pendulum soon return.

1 Response to “Bedside Manner and the Pendulum Effect”

  1. 1 Bettercareelsewhere March 25, 2014 at 2:45 am

    Excellent post! Most enjoyable reading.

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.



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