Bedside Manners and 'Oddly Intimate Encounters' Inside the sterile environment of an examination room, the most intimate conversations take place. Dr. David Watts talks about listening to patients and talking to your doctor.
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Bedside Manners and 'Oddly Intimate Encounters'

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Bedside Manners and 'Oddly Intimate Encounters'

Bedside Manners and 'Oddly Intimate Encounters'

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NEAL CONAN, host:

This is TALK OF THE NATION. I'm Neal Conan in Washington. A 35 year old violin teacher who's rotting from the inside out, so pale and graceful, her doctor says, she looks like a girl in a Vermeer painting. A woman whose husband dies of colon cancer after his doctor failed to order the procedure that might have found it in the early stages. A man who records his bowel sounds and plays them back for his doctor, obsessed with the thought that he might have colon cancer.

Over 25 years as a gastroenterologist in San Francisco, Dr. David Watts has collected stories of his conversations with patients into a new book called Bedside Manners. The 48 vignettes include his relationships with hypochondriacs, patients with enormous courage, some with senses of humor, and many confronting their own mortality.

He reminds us of intimate conversations in clinical settings, how doctors and their patients talk about life and death and fear, about otherwise unmentionable body functions, about pain and hope. Later in the program, the baseball season gets off to an early start later this week, with the World Baseball Classic in Cooperstown. It's a big delegation from the old Negro Leagues.

But first, bedside manners. If you're a doctor, what can patients do to improve their communication with you? If you're a patient, which is all of us, how can doctors improve their relationship with you? Give us a call. Our number here in Washington is 800-989-8255. That's 800-989-TALK. The e-mail address is talk@npr.org.

Dr. David Watts, who's voice may be familiar to you as an occasional commentator on ALL THINGS CONSIDERED, joins us now from the studios of member station KQED in San Francisco. Nice to have you today on TALK OF THE NATION.

Dr. WATTS: Thank you. I'm delighted to be here, Neal.

CONAN: And let me begin by asking you about the story you tell about the violin teacher. We mentioned that.

Dr. WATTS: Yes.

CONAN: It's a story, really, about communication.

CONAN: Well, it is, and it's also about attachment. I mean, there's this whole business in medical school, about the third year, where medical students suddenly feel like they have to distance themselves from their patients. I think that's, not only is that a bad concept, but it leads to poor communication between doctors and patients. This was a story which, sort of accidentally, went against that tendency among physicians to distance themselves…

CONAN: Mm-hmm.

Dr. WATTS: …as if in an attempt to protect themselves from the swirl, that vortex of emotional current that comes around illness and the consequences of illness. I don't think that's necessary at all. I think that, as physicians, we need to be able to connect to the patients, and in that way, be able to better hear their circumstance.

This story was really about the connection that occurred between this very young, very talented violinist, and the doctor that took care of her, which was me, over this illness that she had, which turned out to be a mortal disease.

CONAN: Mm. She came into your office and asked you to check, what did she call it?

Dr. WATTS: Hemoblob.

(Soundbite of laughter)

DR. WATTS: Check my hemoblob. And what she was talking about was this mass that was growing inside of her liver, and even extending the wall of the abdomen a bit over on the side. Now, she had, the curious thing about it is that she'd given it a name. And we do that sometimes, of course, to try, I think, to get power over the circumstance that has hit us. Well, she called it a hemoblob, and it struck me as curious and funny in the midst of a very tragic situation.

CONAN: Mm-hmm. And once, of course, you went in and took a look, you knew what it was.

Dr. WATTS: Yeah, we knew what it was, and it struck us all as a tremendous tragedy, because we could see that this was a very beautiful young woman in many ways, and was being struck by a mortal illness.

CONAN: And there's another conversation you have with her after she's decided to move back home to be with friends and family.

Dr. WATTS: Yes, and that's where that business of connection really comes forth, you see, because she had decided to go back, as you say, to her family, which meant that our relationship was going to have a separation in it, and that's as it should be, because she needed to follow what she needed to follow. But there came a moment in our telephone conversation, as she was preparing to leave, where there was nothing more to say. I couldn't wish her good luck, because I knew she wasn't going to have any.

CONAN: Mm-hmm.

Dr. WATTS: And so, we just held onto that silence for a few moments and let it go as long as it could, and then we broke the connection as we knew we must, which is the finality of the situation.

CONAN: Hmm. The military officers, when they're asked to write after-combat reports, they're very clinical because, obviously, they need to distance themselves a little bit from…

Dr. WATTS: Yes.

CONAN: …things that are, that are just terrible that they're describing.

Dr. WATTS: Right. Right.

CONAN: Doctors are the same way, you say.

Dr. WATTS: Well, when they write in charts, I think they do that. I think they know that what they are writing there is going to be represented as science and observation, and so they tend to distance themselves in that circumstance. That's even changing a bit, you know. I mean, there's a real move to, toward what's called narrative medicine, putting the story of the illness, not just the clinical, precise points of the illness, but the story of the illness into the chart, too, which gives you a great deal more color tones to what's going on.

CONAN: Mm-hmm.

Dr. WATTS: So, I think we do do, in a sense, what the military people do in that circumstance that you alluded to. But it's acquiring more color as we go along.

CONAN: And one of the things that you seem to be saying by implication in this book is doctors have to remember they are treating people, not diseases, or not just diseases.

Dr. WATTS: Absolutely. I mean, I think that, I think that we have a problem, at times, in this country, with what we perceive to be doctors who are cold and distant and unfeeling, maybe harsh. I think that that is unfortunate, because it doesn't need to occur. The doctors don't have to protect themselves in that extreme amount, and they should reach out, and after all, we're dealing with people who are in situations facing illness.

It's almost like you want to say to the doctor, well, you should experience this once in awhile, just to be sure that you understand what we're going through.

CONAN: Our number, if you'd like to join our conversation, is 800-989-8255. That's 800-989-TALK. Our e-mail address is talk@npr.org. Our guest is Dr. David Watts. His book is Bedside Manners: One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer, and let's talk with Mary. Mary's calling us from San Antonio.

MARY (Caller): Hi. I just had to call in, because I'm a pediatric emergency room physician here in San Antonio, and I think that this is just a topic close to my heart, because I love to hear how, I love this aspect of medicine, where the physician gets to have such a wonderfully intriguing relationship with patients and families.

But, one night I was in the emergency room, and I guess I was probably about 40 at the time, and I had finished my interaction with my patient and family, and I had made a diagnosis and talked to them about everything, and I said, do you have any more questions? And the mother said, yes, as a matter of fact I do. And I said, yes? And she said, has anyone ever told you that you remind them of Marge Simpson…

(Soundbite of laughter)

Mary: …from The Simpsons? And I had, that really was a first for me. I'd never had had anybody really tell me that before, and…

Dr. WATTS: Well, that's one of those curious encounters that we have.

(Soundbite of laughter)

MARY: Yes, it is. It absolutely was, and I walked outside to the nurse's station and said, you know, y'all aren't gonna believe this, but this mother just said I remind her of Marge Simpson from the Simpsons, and my colleague who worked with me, she looked it up and down and said, you know, I can see that.

(Soundbite of laughter)

Mary: I can see that, you know, so...

CONAN: Maybe you should have let that blue hair dye alone.

(Soundbite of laughter)

MARY: I was way too young at the time to have blue hair, I'm telling you. But it's a…

Dr. WATTS: Well, I think that's a wonderful story, because it illustrates a lot of what is going on in this book as well, and that is that when we are confronted with heavy situations, we try to find ways to lighten them up a little bit. I mean, Shakespeare knew that. When he was writing his tragedies, he interjected some comedy. And think about it. The comedians that do the work that they do in this country, which I think is marvelous work…

MARY: Mm-hmm.

Dr. WATTS: …really deliver to us some of the heaviest topics that we have ever encountered, and yet they make it palatable by putting a lightness to it. So, I find it extremely refreshing when patients catch me off guard like that. I think that's a great story.

MARY (Caller): Definitely, and I think it keeps us humbled as physicians to realize that we haven't heard it all, and we're never gonna have heard it all.

Dr. WATTS: Well, you know, we as physicians we have a great privilege…

MARY: Absolutely.

Dr. WATTS: …because we are sitting, almost like in a sanctuary…

MARY: Absolutely.

Dr. WATTS: …where human interactions take place at a level. I mean, where else can you have this happen, when you walk in and five minutes later you're talking about the intimate details of your life?

CONAN: Maybe the confessional, but go ahead.

Dr. WATTS: Well, that's true, but this is also wrapped around with a physicality to it, which has to do with illness, healing, mortality. I mean, all the layers of the things we worry about in lives, or are grappling with in lives come out very quickly in the doctor's office.

MARY: And if we forget that that is, what a privilege that is. I think that's…

Dr. WATTS: It's a great privilege, but it's also a great responsibility. And in that sense, we have to always be on our toes to do no harm.

MARY: Absolutely.

CONAN: Well.

MARY: Well, thank you for allowing me to call in and participate.

CONAN: Okay Marge, thanks very much.

(Soundbite of laughter)

Mary calling us there, from San Antonio.

You talk about this privilege though, in that, you know, very quickly, almost with no introduction, doctors expect patients to tell them things that they would never tell anybody.

Dr. WATTS: Yes, and part of that is the covenant, I call it, of the doctor/patient relationship. It has evolved to that. It didn't always start out that way, I don't believe, but because of what we have come to as a level of trust, and I'd have to say that there are some areas where that is breached all the time.

CONAN: Mm-hmm, sure.

Dr. WATTS: But we do have, I believe, a certain level of trust that occurs. Not only that, the doctor/patient relationship depends upon that to work. Because if the patient does not come forward with the symptoms and the emotions around the symptoms, how can they be dealt with? How can they be diagnosed properly?

So, there's this immediacy. There's a little story, which is not in the book, about a patient who came in my office one time, and I, something about her made me just want to let her talk. She had headaches for many years, no one had been able to diagnose it properly.

And so I just let her talk, and within five minutes, she was talking about her husband, and how she realized last week that she just didn't want to be in the same elevator with him. And did I think that that had some importance to it?

That's a dangerous moment, because while you and I might believe we know what that is, to come out and say, well, that means you should do this and that and the other, is intervening in the life in a way which I don't think we're given privilege to do. But, you can certainly recognize the little sparkles that come up when they do.

And I just recognized and said, yep, I think so, and you should think about it. You know, she came back two weeks later, and she had divorced her husband, and the headaches were gone. Just like that. So, that's the magical kind of thing that can happen in this arena that we are privileged to have in the doctor/patient relationship.

CONAN: We're going to have to take a short break. More of your questions for Dr. David Watts when we come back; 800-989-8255, if you'd like to join the conversation, or zap us an e-mail: talk@npr.org.

I'm Neal Conan this is TALK OF THE NATION, from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan, in Washington. Our guest today is Dr. David Watts, he's written a book called Bedside Manners: One Doctor's Reflections on the Oddly Intimate Encounters between Patient and Healer. It's based on his 25 years as a gastroenterologist in San Francisco. Of course, you're invited to join the conversation: 800-989-8255, 800-989-TALK, e-mail us talk@npr.org.

And let's get another caller on the line. This is Kevin, Kevin's with us from Cleveland.

KEVIN (Caller): Hi, how are you?

CONAN: I'm well, thank you.

KEVIN: This is a great subject, very close to my heart. In 1979, I broke my neck, and I love this doctor, because he saved my life, but he had absolutely the worst bedside manner on the planet. For example, when he's screwing in the last screw of that halo brace, he said, right in front of me and all the nurses, oh, the last guy I put one of these one died.

(Soundbite of laughter)

KEVIN: And then after I get the halo…

CONAN: I don't mean to laugh Kevin, but it's funny.

KEVIN: Oh it's a…

Dr. WATTS: Yeah, it's funny all right.

KEVIN: …no I still laugh about it all these years later. Then, when he takes the halo brace off, I get the x-ray done to see how every things lining up. He put that thing right up in the lighted board and he says, uh-oh. I felt like I was in a Bill Cosby skit.

(Soundbite of laughter)

KEVIN: But, like I said, this guy, he saved my life. When they wheeled me into the emergency room, he's giving orders to everybody else, and he doesn't say a word to me. And I wanted to ask him about a million questions about what I can expect, and he gets right in my face and says, look you're going to walk again. I deal with people that never are gonna walk again, just do what I tell you. And that was it, that set the tone for the whole relationship with this guy.

CONAN: Well…

KEVIN: I'd like to hang up and get my, your comments on the air, but thanks for letting me let that out.

CONAN: Okay, Kevin, thanks very much.

Dr. WATTS: Well, it sounds like Kevin got some direct advice, it was very useful, and a great deal of technical help from this doctor.

I mean, there are doctors you hire for various reasons. There are some that you hire for technical reasons, that can put together things or take out things, or work with their hands in certain very important ways to us. And then there are doctors that you hire to sort of be the over-viewer.

CONAN: Hm.

Dr. WATTS: The one that puts everything together, that sort of attends to the different aspects of your life. Clearly, this doctor, the doctor of Kevin, was a doctor specifically for taking care of just that aspect of his body. And it looks like it was a great outcome. So, I suppose there are a lot of different ways to approach the relationship. Just so long as it works in the long run.

CONAN: As long as it works, but nevertheless, I mean, when you know you hear your doctor say, uh-oh when he puts up the x-ray, maybe a little filter there…

Dr WATTS: Yeah, I think.

CONAN: …would be helpful.

Dr. WATTS: I agree, I agree, I got a little shock when I heard that. And I was, there's part of it which says, okay, let the personality come out, because we're more credible when our personality shows forth. On the other hand, one must consider the impact of what that personality is having on the patient in the room with you.

CONAN: Mm-hmm.

Dr. WATTS: So that if you are going to say something that's going to set them back, make them worry, make them fear, I think we have to have pause, I agree.

CONAN: Yeah, and obviously, for twenty years, Kevin has been nursing this grudge.

Dr. WATTS: Yeah, he finally got it out on National Public Radio.

CONAN: There you go. Let's see if we can get another caller in. Bobbie, Bobbie's with us from Boise, Idaho.

BOBBIE (Caller): Hi, I just wanted to mention that my grandfather was a doctor, and, during oh, the ‘30s, ‘40s, and that era where they, everyone really looked at the doctors as second only to God.

And I think that he died younger than he needed to, because he took that so much to heart. He felt an incredible burden that he was totally responsible for these people's lives. They didn't. It wasn't as much as of a team effort to help someone regain health or maintain health.

Dr. WATTS: Yes, I agree, it was a very hard job back then. I mean, you were everything to everybody, and you probably got paid sometimes in poultry and eggs…

BOBBIE: Absolutely.

Dr. WATTS: …and things like that. It's a romantic concept of that time. On the other hand, it was very hard on the physicians to have to do all of those things. I would guess, though, just listening to it, that, and you can tell me if I'm right or not, that he had great pleasure and great sense of satisfaction having done that.

BOBBIE: Oh yeah, I mean, he absolutely loved what he did. I mean, you know he, I mean, I've met people, I'm from Idaho, and I've met people that I have never met in my entire life that lived in a totally different city, and we'd somehow meet, and they knew him, and they remembered him all those years. And so, it was a very deeply personal thing. And he absolutely loved it.

Dr. WATTS: Well, what we want in modern times, really, is to be able to take that spirit that he had, and bring it into a highly technological world.

BOBBIE: Right.

Dr. WATTS: And make it work for us.

BOBBIE: Yeah, yeah.

CONAN: Bobbie, thanks for the call.

BOBBIE: Thank you.

CONAN: Let's talk now with Philip. Philip is calling from St. Augustine, in Florida.

PHILIP (caller): Yes, hi Neal, hi Doctor. It's a pleasure to be on your show.

CONAN: Thank you.

Dr. WATTS: Thank you.

PHILIP: I had a, this ones a little bit negative, unfortunately. My moms is in an assisted living, and her physician taking care of her when she was in the hospital, when they dismissed her from the hospital, there's an 1823 form that the doctor signs so that she can get all of the medication that she takes when she goes back to the assisted living.

And, unfortunately, he waited about two weeks. So, out of frustration, I had written him a letter saying what an inconvenience that was for my mom, and putting undo pressure on her. With that, he sent me a letter and dismissed my mother as a patient…

Dr. WATTS: Uh-oh.

PHILIP: And I was wondering what your feelings on that was.

Dr. WATTS: I think that's wrong, there's no question about that. I mean, part of the responsibility we have, and I don't like paperwork, either. And I have to admit, it stacks up, occasionally, on my desk a little bit. But…

PHILIP: What does one do if you have a problem with a doctor, since letters seem to be a dismissal?

Dr. WATTS: Oh, my goodness. Well, I think you have every right to expect that the physician is going to be diligent about doing that side of the practice. The practice is not just sitting down in the office and having a nice conversation. It is following through. It's getting the right tests, it's getting the right referrals, it's making sure that the patient is placed properly in the hands of people who are going to take care of her, and all the paperwork that has to do with that. The system is burdened with paperwork, I have to tell you. And several of the stories that I have in this book…

CONAN: Mm-hmm.

Dr. WATTS: …are responses that I have against that burden.

CONAN: But the bureaucracy…

Dr. WATTS: The bureaucracy in general, but my take on it, I mean, my response to it is to try to improve it. Try to make it more efficient, but not to ignore it. And I think the physician just took umbrage with your insistence, and that was wrong on his part.

CONAN: Mm-hmm.

Dr. WATTS: Because we have to be open, as physicians, to the umbrage we receive for things we haven't done. And then just make that correction. I mean, just do it.

PHILIP: Well, thank you both, I wish other people out there with this same situation have better luck.

CONAN: Okay.

Dr. WATTS: I hope so, too.

CONAN: And good luck all around, Philip.

PHILIP: Thank you.

CONAN: Bye. I wonder, um, there are all kinds of fancy, new technological means for diagnoses. Wonderful machines that…

Dr. WATTS: Right.

CONAN: Again, it's sort of an analogy to an intelligence. Great technical means, but a lot of the time, human intelligence, sitting and just talking to somebody.

Dr. WATTS: There is never going to be a replacement for which you just pointed out--the taking of the history and the physical examination. One on one with a doctor and a patient is where it all starts, it's where it all happens, it's where the best information comes forth.

Because you can line up data, and statisticians will tell you this, to prove most anything you want to. What you have to be able to do is to have the wisdom to know which data to give weight to. And that wisdom comes when you know the person, when you know the story of the illness. When it fits together with how that works as it moves through time.

Only in that way, I think, is technology of great assistance to us. We can't rely entirely, there's not going to be a machine that you put a body into and say, okay, here's the diagnosis, here's the emotional content, here's the spiritual level.

CONAN: Mm-hmm.

Dr. WATTS: It has to have that human touch.

CONAN: Finley's(ph) calling us from Jacksonville, North Carolina.

FINLEY (Caller): Hi. Good afternoon, how are you?

CONAN: Very well, thanks.

FINLEY: Good, this is a real driveway moment, I'm sitting in a parking lot waiting to go into see my dentist, who is a very dear friend, and she always checks and sees how I'm doing before she starts poking around in my teeth.

But my comment is on how to improve the relationship between patients and medical staff. It seems to me that often when I go into a clinic or somewhere where I don't really know the people, that I'll be sitting in a waiting room, and someone will come in, and without saying anything, they'll just start poking and prodding and asking me questions. Simply introduce yourself, say I'm…

Dr. WATTS: Yeah.

FINLEY: Physicians assistant, or doctor or whatever. And just let me know who you are. That gets us off to a really good start.

Dr. WATTS: Yeah, I don't like the idea of having patients lined up in examining rooms, cold, in smocks of some kind, half naked and have…

FINLEY: Yeah.

Dr. WATTS: …doctors parading through in and out very quickly. It's efficient in one way, but it is dehumanizing. And one…

FINLEY: Well, usually, when that happens to me, I stuck out my hand and like I'm a waiter say, hi, I'm Finley, I'm going to be your patient for today.

Dr. WATTS: Thank you very much.

FINLEY: And…

Dr. WATTS: I would accept that very well. I think it's a great idea.

CONAN: Yeah…

FINLEY: I usually say who I am, or who they are, and that works pretty good.

CONAN: Yeah, almost especially the practice of rounds, where doctors are trying to, you know, obviously, teach young physicians. But people feel like, you know, just a piece of meat out there.

FINLEY: Indeed, that happens a lot. Yeah.

Dr. WATTS: Academic physicians round too much, that's my opinion.

FINLEY: I need go in and get my teeth worked on, can I give a plug for my dentist?

(Soundbite of laughter)

CONAN: Yeah.

FINLEY: Dr. Martha O'Hara in Jacksonville, North Carolina, she's a great friend.

CONAN: All right, Finley, good luck with the dentist.

FINLEY: Okay, thanks a lot.

CONAN: Bye-bye.

FINLEY: Bye.

CONAN: Let's move along and talk to Verune(ph), am I pronouncing that right?

VERUNE (Caller): That's right. (unintelligible)

CONAN: In Cupertino, California. Go ahead.

VERUNE: Yeah, see basically, I come from a country in India, and there, when the doctor have to break a bad news to a patient, normally they don't do it right up front, as it's being done in the U.S. In the U.S., doctors give the worst cast scenario and things like that, but in India, for example, if a young person has got cancer, a doctor will not break the news immediately to the patient itself, but will probably work around with their parents and things like that. So that, you know, there is a ramp up, and the patient doesn't get a shock of their life.

So, I think the patient gets more prepared, slower over a period of time to hear the bad news. And I can understand, because the social set up in India is pretty much different than what's there in the U.S. So, I think that's another view to look at it. Just thought I'd share this with you, and I'll take the response off line.

CONAN: Thanks for the call, Varune.

VARUNE: Thank you.

Dr. WATTS: It's an excellent point, and there are very definitely cultural differences in the way in which we handle and view illness, and how to be upfront or not upfront about it. For example, I've had some Chinese patients who protect their mothers and their fathers from the diagnosis forever, so that if they get a diagnosis of cancer, they will not tell them.

Perhaps that's cultural, perhaps that's individual to certain people. On the other hand, physicians need to be responsive to the possibility of cultural or familial differences among the people that they are treating, and try to administer to them at a level which resonates within that system.

CONAN: Mm-hmm. There's a story you tell in the book about a young Latina woman who keeps coming back in with a sexually transmitted disease…

DR. WATTS: Yeah.

CONAN: …and you discover the problem.

DR. WATTS: Yeah. I mean, it was phenomenal to me, a shock. In that situation, the lover, the man, refused to admit that anything could be wrong with him. He was the carrier of the disease, and he kept giving it to this woman, who disseminated, who had a tremendously bad infection and had to be given intravenous antibiotics, and almost died a few times, and she kept coming back. And I was perplexed.

I said to her, why don't you make him get treated, or why don't you leave him? And she said, I love him. And I said, yeah, but you could get killed by this. And she said, well, he will not admit that anything is wrong, and in my culture, and in his particular mind, that's the way it has to be.

And that was a shut door. There was nothing more that I could do about it, but it had a lot to do with the kind of differences we're talking about.

CONAN: Dr. David Watts is our guest today. His new book is Bedside Manners: One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer. You're listening to TALK OF THE NATION from NPR News.

And let's get Justin on the line. Justin is with us from Lenexa, is that right, in Kansas?

JUSTIN (Caller): Correct.

CONAN: Okay, go ahead.

JUSTIN: Yes. I was just wanting to comment that I can definitely relate to the topic of the conversation today, in regards to communication going beyond the levels of just expressing symptoms and having a diagnosis. I was diagnosed with retina blastoma, which is a fairly rare retina cancer, at the age of six months old, and I have had the same doctor, I'm now 29, I've had the same doctor now ever since then. I still go in for annual check-ups.

I've developed a great relationship with this doctor here in Kansas City. We send each other Christmas cards. He's been to my wedding. He's met my little girl. And it also makes me aware of, when I see other doctors for other things, there's a definite difference in the relationship that I've developed with this doctor, and definitely makes you aware of the doctors that really don't go beyond that level.

DR. WATTS: Well, that's like family, isn't it? Doesn't it feel like family to you?

JUSTIN: Oh, yes, definitely.

DR. WATTS: Yeah.

JUSTIN: Yeah.

DR. WATTS: I love that. I think that's terrific, and I used an analogy like that when I was teaching a class one time to some medical students, and the director of the course says, you know, we don't like to talk about it as if it were family. I said, why not? And they said, well, you know, we have to protect ourselves and keep a distance. You know, that old philosophy, la-la-la-la-la.

JUSTIN: Sure.

DR. WATTS: And I just said, no, no, no, no, no. This is, there's nothing harmful about feeling like you're a member of the family. In fact, it really solidifies the relationship. And frankly, I think a lot of the law suits that happen in this country today take place because of rudeness, because of distance, because of inconsideration on the part of the physician. Whereas, if they would open up and be close like your physician is, sounds like he's done a great job with you, it would be a lot better.

JUSTIN: Oh, yeah. In regards to…

CONAN: Just hold on for a second, Justin. I want to say, a lot of doctors say they don't have the time to do that.

DR. WATTS: Oh, I don't think that's right. You know what, my visits have gotten shorter and shorter, and the depth of those visits has gotten deeper and deeper. Part of it has to do with experience, yes. Part of it has to do with the fact that I'm writer, because as a writer, your antenna are always up. I mean, you're always paying attention. And so, that helps being a doctor quite a bit, to be paying attention all the time.

And so, if every minute you have, I mean, you have a little jocularity, you have a little human touch, you have a little business about, you know, how are you today, what's your family like, and so forth. Just a little bit of that sort of thing, even though you can't go into great detail, it signifies, it's like the tip of the iceberg. It signifies that whole resonant chamber that you've created in the nature of the relationship.

CONAN: Mm. Justin, I'm sorry, didn't mean to cut you off.

JUSTIN: Oh, no problem. I was just going to also comment in regards to the trust that that builds. I've only had a few medical problems, but at the age of 12, I also developed a tumor in my cheekbone that was the size of half your fist. And actually, it was a little bit out of the scope of my retina doctor's realm to be able to take care of that, so I traveled up to Pittsburgh and had a team of physicians perform that procedure.

I also developed a relationship with that doctor. He since has moved his practice to Baltimore, and I developed a, just a speckle of a melanoma on my collarbone. Something that could have been removed in almost an office setting, but the amount of trust that I developed in the relationship with that doctor was so great, that I actually traveled out to Boston just to have that doctor remove that little speckle of melanoma, because I knew and I trusted him. I knew that I wouldn't have to worry about it again.

DR. WATTS: Way to go. I say way to go. I think that's perfect. Trust is critical. Think about it. I mean, you have to subject yourself to indignities, to anesthesia, to surgery, to somebody cutting on your body, to somebody putting you to sleep and waking you back up again. How could you possibly do that without trust?

JUSTIN: Sure. Well, thank you for taking my call.

CONAN: And thank you for calling, Justin. Appreciate it. I guess those indignities begin with those silly gowns. Why do we have to wear those gowns? I don't understand that.

DR. WATTS: I agree. I'll tell you. Well, you've got to get beyond the clothing somehow, because to be a physician, that's one of the intimacies that it requires, but they could do a little better on the design, don't you think?

CONAN: I think they could. Anyway, there's a challenge for all you clothing designers out there. We're going to take a short break and come back with more of your questions for Dr. David Watts. His new book is called Beside Manners. We're also going to talk, too, about new inductees to the Baseball Hall of Fame, among them a woman. Cooperstown's first. Stay tuned. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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CONAN: This is TALK OF THE NATION. I'm Neal Conan, in Washington.

Here are the headlines from some of the stories we're following here today at NPR News. International donors are trying to head off a finicial crises in the Palestinian authority. The U.S. considers Hamas, which won recent elections, a terrorist organization, and says any future Palestinian government must recognize Israel and renounce violence if it wants outside support. And the trial of Saddam Hussein and seven co-defendants resumed today in Baghdad, but with ongoing violence, and fears of outright civil war, Iraqis say they're simply not that interested in the trial. At least, not right now. Details, and, of course, much more coming up later today on ALL THINGS CONSIDERED from NPR News.

Tomorrow at this time, on TALK OF THE NATION, murder can happen anywhere--how we tell the story depends on where we live. That's the idea behind a new series of mysteries. We'll talk with the writers, and we'll hear from you. Where are the bodies buried in your town? That's tomorrow, on TALK OF THE NATION.

Today, we're talking with Dr. David Watts. He's the author of Bedside Manners: One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer. And here's an email we got from a doctor named Gordon. And he says: “I'm an E.R. doc, I love my patients, feel privileged to help them, but there are so many rough characters out there. Frequent issues include: drug-seeking, and people that use an ambulance as a taxi service, and scam artists of all stripes. Turn the druggies down, or try to redirect bad behavior, and it might be a letter to the medical board. Where do I go to complain about the patients?

DR. WATTS: Boy, he brings up a tight situation. There's a story in the book about how I had to struggle and struggle and struggle with the dealing of a patient who I believed to be exhibiting drug-seeking behavior. And it's called the third satisfaction. The first satisfaction, I discovered, in taking care of patients, by taking care of someone who wasn't very satisfying, was that I needed to feel a sense of gratitude. That was a new observation to me. I didn't know that before I had started taking care of this patient and writing about it.

So, I reckoned that, if I wasn't going to get satisfaction in the way of gratitude or cooperation, that I was going to have to get it in terms of doing my job in the most excellent way that I possibly could, so that I could feel confident that at least I'd done what I could. But that ended up separating the two of us a bit. You know, distancing the relationship a bit, and it really wasn't working very well.

CONAN: Mm-hmm.

DR. WATTS: And there came a point where there was a crisis. I caught her doing drugs, and she denied it, and she fired me. She fired me as a doctor. Now, the end of this story is that she went out a year later, showed up in an emergency room, went to an ICU, and died. And, I'm thinking, well, could I have made any difference if I had stayed around? Probably not. But I still have to deal with that notion in my mind that somehow, I'm now not in the position to be able to help or to take care of her.

CONAN: Mm.

DR. WATTS: So, is it possible, and this is an ethical question, that we bend the rules a little bit to help take care of people who present us such phenomenal problems, in the way of personality, by giving her a little bit of her drug maybe, you know, as a therapeutic thing, but fighting against all odds to keep her from being addicted. Is that going to put us in a better position to take care of her in the moment? I mean, to perform what physicians are supposed to perform. Now, his question really was, who do I go to to complain about that? I don't know. I think that may be just part of what we inherit as our legacy as physicians.

CONAN: Let's talk with Debbie. Debbie's giving us a call from Vancouver, Washington.

DEBBIE (Caller): Hi.

CONAN: Hi, Debbie.

DEBBIE: What I'm wondering is, in medical school, what type of classes, or is there any class that deals with this type of topic, you know, the bedside manner?

DR. WATTS: Boy, you have asked my key question. That's my hidden agenda. Medical schools, for all the good they do, don't really do a great job of taking care of what you're asking about.

DEBBIE: Okay.

Dr. WATTS: The most boring lecture I ever sat through was one on compassion. And I am absolutely interested, I'm passionate about compassion. But you can't talk about it. You can't stand up and rationalize it. You can't analyze it. You can't say it's body language. You can't say it's eye contact.

That stuff all follows if you have compassion inside to begin with. But it doesn't come that you do the outside stuff, and you generate compassion. And that's how medical schools have sort of handled the problem. Now, they're doing better. I mean, I don't mean to generalize so badly about that, but the way in which you would do it in medical schools is by example. You would have role models that are capable of doing that.

CONAN: And we seem to have lost our connection to KQED in San Francisco. Dr. Watts is at our member station there, and probably as a result of the arrangements we made for this session, Doctor, are you there? No? I thought I heard, hello? Are you there, Dr. Watts?

Dr. WATTS: Are we here?

CONAN: I can hear you. Can you hear me? He can't. Obviously, can't hear me…

Dr. WATTS: I'm here, can you hear me?

CONAN: Yes, Dr. Watts. Can you hear us?

DEBBIE: Hello?

Dr. WATTS: Yes, I'm here. Can you hear me?

CONAN: Yes. Yes. Maybe we're going.

Dr. WATTS: Yes.

CONAN: Go ahead doctor, finish up.

Dr. WATTS: Okay. I was going to say that the role models are the practicing physicians. And if you put those in front of the medical students you will show them by example how to do compassion.

Because the practicing physicians are they who get daily reminders in the way of rewards for the compassion that they have shown to their patients. Now in the absence of that, I think stories, stories like mine and others who have written about these things, if they are authentic, if they are honest and straightforward, stories can do that job. Because you vividly imagine these situations when you're reading them and bring all of your own talents to them.

CONAN: Debbie, thanks very much for the call.

DEBBIE: Thank you. And if I could just add one more thing?

CONAN: Go ahead.

DEBBIE: The reason that I'm with the doctor I'm with now is because I went on a search to find a doctor that I felt had compassion for what he was doing in the service he was performing, and that's why I'm with him.

So, thank you.

CONAN: Okay. Thanks very much, Debbie.

Those stories Dr. Watts has collected are in his book, Bedside Manners: One Doctor's Reflections on the Oddly Intimate Encounters Between Patient and Healer.

Before we let you go Dr. Watts, one more email…

Dr. WATTS: Sure.

CONAN: …this from Rebecca in Portland. What's with all the baseball references doctor's use? My uncle, who just passed away a week ago, was told he was in the ninth inning, and my mother-in-law who passed away four weeks ago was told not to expect a home run with her last chemo.

Dr. WATTS: Well, I'm guilty of that, too. I said clean base hit--in one of my stories. I think that physicians are ore than physicians; they are athletes, they are musicians, they are art appreciators, and in fact all those things that we can bring to our experience as a physician, everything that we can experience in the way of human understanding and challenges, are ways that enrich us and enrich the relationships that we have.

I wouldn't be surprised to find references to Van Gogh or Vermeer or other people too, from time to time.

CONAN: Maybe even in baseball?

Dr. WATTS: Maybe even in baseball.

CONAN: Dr. Watts, thanks very much.

Dr. WATTS: It's my pleasure.

CONAN: Dr. David Watts joined us from our member station in San Francisco, KQED. And more baseball coming up.

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