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A $42 Million Gift Aims at Improving Bedside Manner
Carolyn Bucksbaum still bristles about an arrogant physician who brusquely dismissed her intuition about her ailment decades ago. It turned out she was right. The physician was wrong.
“We all make mistakes,” she said. “But he never even apologized.”
Years later, Ms. Bucksbaum and her husband, Matthew, would come under the care of Dr. Mark Siegler at the University of Chicago Medical Center, a doctor they found compassionate and humble. “He goes by Mark,” Ms. Bucksbaum noted approvingly, “not ‘Doctor.’ ” Medical students, they thought, could do well to emulate him.
Now, the Bucksbaums are donating $42 million to the university to create an institute devoted to improving medical students’ handling of the doctor-patient relationship. The Bucksbaum Institute for Clinical Excellence, to be announced Thursday, will be led by Dr. Siegler.
“To care for a patient,” Dr. Siegler said, “you have to care about a patient.”
If it seems like a lot of money for teaching good bedside manners, researchers point to many studies that indicate a good rapport between doctors and patients strongly correlates with favorable health outcomes.
Nearly all medical schools teach the importance of listening to patients and showing empathy. But the Bucksbaum Institute is an ambitious effort to put compassion and empathy, as Dr. Siegler puts it, “on the same pedestal as science and technology.”
Medical education experts say the human dimension is sometimes crowded out by discussions of the latest technological innovations. Practicing doctors face their own pressures, said Dr. Laura Roberts, chairwoman of the psychiatry department at Stanford University.
“The modern world of medicine,” Dr. Roberts said, “has become bureaucratized, distant, regulated.”
In Dr. Roberts’s view, the University of Chicago initiative will be unparalleled in its goal to “preserve the sense of kindness” in medical students before those attributes “get beaten out of them” during training and practice.
The institute will develop new courses on the patient-doctor relationship and rely heavily on junior faculty members and older practicing clinicians as mentors. It will also offer electives in the doctor-patient relationship to those students who are not scholars in the program.
With almost a third of University of Chicago Medical School students going on to careers at academic medical centers, the innovations will “pollinate medical care across the country,” said Dr. Holly Humphrey, the dean.
The subject has stirred passions and debate for as long as people have been treated by doctors. Some 2,500 years ago, Plato complained about the paternalism that characterized some doctors. “He gives off some empiric treatment with an air of knowledge in the brusque fashion of a dictator,” the philosopher wrote, “and then rushes off in haste” to the next ailing subject.
Medical experts say it will be a challenge to find more time for doctors and patients to bond, because every moment costs money. But Dr. Humphrey said the need was clear. She pointed to research showing that patients who had good relationships with their doctors were more likely to follow health regimens and to overcome illness.
She said studies had found that patients provide important clues about their health status during leisurely conversations with doctors. As one adage among doctors has it: If you listen long enough, patients will tell you exactly what is wrong with them.
Dr. Wendy Levinson, chairwoman of the department of medicine at the University of Toronto, has written that tone, or the way a doctor says something, can be as important as the substance. Primary care physicians who use humor, she noted, are less likely to have been sued.
That comes as no surprise to Robert Kreisman, a medical malpractice lawyer in Chicago. “In good relationships, folks don’t call lawyers,” he said. “What I hear a lot is that doctors were rude or uncaring.”
The Bucksbaums are Iowa natives who moved to Chicago 11 years ago. Mr. Bucksbaum made a fortune by building shopping malls. Both attended Grinnell College, where Ms. Bucksbaum was the editor of the school newspaper.
Sitting at a glass table in their 70th-floor apartment, Ms. Bucksbaum reminisced about the people she had known over the years who entered medical school with a burning desire to comfort others, only to somehow lose their gift for the human touch.
“I have wondered, ‘What is it that changes them?’ ” she said. “And can something be done about it?”
The Bucksbaums were inspired by Dr. Siegler, a leading medical ethicist who has been a general practitioner for more than 40 years. He still makes house calls. His business card includes his cell and home telephone numbers. And, not least, as Ms. Bucksbaum tells it, he treats his clerical workers and others in his office as colleagues, not underlings.
“You know how it often is: the aide is just ‘Mary’ and then there’s ‘The Doctor,” Ms. Bucksbaum said. “When the doctor is decent to the person who is working the desk, that worker is more likely to be courteous to the patient who calls in.”
She said that perhaps the most telling moment about Dr. Siegler came when Mr. Bucksbaum needed exploratory surgery for what doctors feared was lung cancer. As the general practitioner, Dr. Siegler was not needed for the surgery, but he showed up anyway in his scrubs.
When the medical team found signs of infection, not cancer, Dr. Siegler led the stunned and delighted medical team in a spontaneous burst of loud applause, Ms. Bucksbaum heard later. He soon rushed out to see her.
“He was beaming,” she recalled. “It showed he really cared.”