If you want to hear about some bad bedside manner, I highly recommend a recent episode (“Goo”) of the podcast Two Dope Queens, starring Jessica Williams and Phoebe Robinson. Williams found a lump in her breast and made an appointment to get an ultrasound to find out what it was. She talks about her experience with the ultrasound and subsequent biopsy, and highlights a couple of unfortunately all-too-common negative patient experiences along the way. I’d chalk these experiences up to at least two dynamics: Lack of empathy, and lack of communication.
Here’s Williams’ recap of the ultrasound itself (edited for length):
[The technician] just wasn’t talking to me about it. Like it was very intimate, like she was squeezing [my breast] and moving it . . .if you could just imagine like the oldest, crustiest lady, that’s who was doing that. Anyway there it was [on the screen], just like a lump. So she’s like “There’s a mass here,” and then she walked out of the room. And so she just left me in the room, so I was just sitting there with my titties out, goo on me, and a picture of my lump. And I was like, “This is really scary.”
So I’m starting to get scared. And then this doctor comes in and the way that he comes in is that he just stands, he like wavers in the doorway. And I was like, “You can, please come in here. Like come touch my breast. Tell me it’s going to be ok.”
So after examining her, the doctor advised her to come back for a biopsy.
And I was like, “What the fuck is a biopsy?” And he was like, “You know what, she’ll explain it to you. I’ll see you later. Bye!” And then he just like . . . faded out of the door. He’s just basically like, I’m not worried about it, see you later, and then he ghosted out of the room like he’d just delivered a pizza and that was the end of the transaction.
There are so many things wrong in this scenario. First, if you put yourself in Williams’ shoes, she’s vulnerable both physically and emotionally. She’s half-dressed and covered in ultrasound gel. She’s made an appointment because she’s worried about possibly having cancer. And now she’s seen visible evidence of a lump but has been given no information or comfort from the staff. Neither of the medical professionals have treated her with empathy in this situation. Neither appears to be considering how the visibility of the ultrasound images or the medical terminology being used might frighten a patient without the background to interpret that information. And neither seems to care that she’s exposed while the doctor stands in the doorway.
Second, neither one of the providers is making a productive intellectual connection with Williams, either. The doctor doesn’t provide her with in-context education that helps reassure her and teach her about the tests she’s being asked to have. Rather, he passes the baton to the technician, who’s already failed to provide a voiceover for her actions during the initial ultrasound.
Unfortunately, things did not get better. Here’s how it went when Williams returned for her biopsy:
We’re just waiting in this room and I just see this surgical table. And it’s just, alcohol on the table and just like the longest needle I’ve ever seen, and I was just like “Oh shit.” Because basically with a biopsy, they take this really—plenty of women get it, it happens all the time, but—they take this really long needle . . . and they get a piece of the mass so they can test it and make sure it’s non-cancerous.
So anyway the doctor comes in with the nurse, and the first thing he does, without—this is the same guy, by the way—without being like, “Hey how are you, you’re probably really nervous,” because I’m scared shitless. He just like grabs the needle and he starts flicking it.
Phoebe then interjects, “What is he, a fucking movie villain? Is he fucking Jafar? What is he doing?”
So he was basically my Jafar. And he’s just talking to me, he’s like, ok this is going to be really quick. Just lay down and assume the position—which is like the ‘paint me like one of your French girls’ pose. And so I laid back . . . and I was like, “Hold up, what are you about to do? Speak to me!” And he was like, “Oh yeah, I’m just going to put this [needle] in here and have like local anesthetic and then you know, then I’m gonna take this really long-ass [needle] and just stick it in there.”
So first he does the [smaller] needle, and . . . I just can’t feel anything anymore. . . And then he takes this long-ass needle and then sticks it into my boob . . . and then all of a sudden he presses this button on this needle and it’s like WHACK!
And I was like, “What the fuck?” And it was so loud that even the ultrasound technician, the nurse, moved my boob because she got freaked out. And he was like, to me, like it was my fault, he was like “Hold still.” Really, you think I moved my titty on my own? OK. But that’s crazy because that means that the woman he works with like a thousand times a day was like,“I got scared.”
And so then I was like “What just happened?” and he was like “That was actually the needle grabbing the mass . . . sorry I didn’t warn you, ha ha.” Like WHAT?
Phoebe responds, “You need to narrate this like this is a Ken Burns documentary. I want to hear everything.”
This is like public radio, talk me through it.
So I was like how many more times is that loud-ass popping sound going to happen? And he was like probably about three or four. And then he just didn’t warn me three or four more times! And I was like, Oh hell no. The good thing is that it didn’t hurt at all, I was just pissed.
Providers may try to protect patients by sparing them from scary or mundane details (or maybe they feel too busy to take the time to explain them). The result can be a terrified patient not equipped with the information she needs to keep her wits during a procedure. Or it could be an angry patient, who feels unprepared and not cared for by her providers. Information is key to helping people emotionally ready themselves for difficult health procedures. It can also be the difference between someone who complies with recommendations–because they understand how those recommendations can support their health–and someone who does not.
A better version of this story would have providers who gave thought to Williams’ vulnerability (helping her cover up when she wasn’t being examined, for example) and offered her just-in-time information for reassurance (such as explaining what she could expect to see, hear, and feel during her biopsy). These small changes probably wouldn’t take much extra time for the providers, and they’d greatly improve the patient experience.
Have you heard of (or personally had) this type of patient experience? What do you think went wrong and how could it be better?
(The good news: Williams’ biopsy was negative.)