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Czech doctors to start lessons in bedside manner

New courses aim to change the medical 'authoritative approach'

By Jana Donovan
For The Prague Post
May 23rd, 2007 issue

For Caroline, a French woman married to a Czech man, a Prague hospital stay four years ago proved to be the most humiliating experience of her life.
After she delivered her first child by cesarean section, she spent 24 hours in the intensive care unit for monitoring. Already separated from her baby, who was not allowed to stay with her in the room, Caroline was further distressed that doctors had not told her that her husband was prohibited from visiting.
“I was crying the whole time, but nobody had any sympathy,” she says. “On top of that, in the morning the door was thrown open and about 10 doctors and medical students walked in the room. Without asking, they removed my blanket and nightgown, and started touching and closely examining my scar.”
The insensitive approach of doctors and nurses, and their poor communication with patients, has long been something of a dark cloud over professional medical care here.
Now, the Czech Doctors’ Chamber, the national association of doctors, has decided to do something about it. On May 14, the organization unveiled a series of new courses to train doctors in how to better communicate with patients. The courses are due to start this fall.
“According to our statistics, the great majority of complaints against doctors are not because of malpractice, but because of their manners and improper communication,” says Milan Kubek, president of the Doctors’ Chamber.
The courses are to be part of a compulsory continuing education program for physicians. By attending them, doctors will accrue credits necessary to keep their licenses.
Select psychologists will teach doctors how to deliver bad news to a patient or a relative, how to deal with people under stress or with aggressive behavior, and how to treat patients as human beings with feelings rather than simply as diagnosis numbers.
Lenka Lorencová, a mother of two, welcomes the training. “When our little son was hospitalized after being hit by a car, we wanted to bring our 5-year-old daughter with us to see him,” Lorencová says. “But we were strictly told by the head of the department that children were not allowed to visit. So what did we do? We simply ignored her.”
Patients shouldn’t have to resort to disobeying doctors’ orders, says Bohuslav Svoboda, dean of the Third Medical Faculty of Prague’s Charles University. “In modern medicine, a patient must be taken as a partner who has the right to make his or her own decisions based on the doctor’s information,” Svoboda says. “So far a somewhat ‘authoritative approach’ has been rooted. Doctors here tend to think they are the only ones who can decide what is best for a patient. And it’s hard to change that mindset.”
A medical revolution
Following the 1989 revolution, the university began providing medical students with courses in communication. Those lessons are part of compulsory classes in psychology and medical ethics in which students are, for example, asked to lead a dialogue in a simulated situation.
“The problem is that young doctors learn from older colleagues. And, unfortunately, with older doctors, it’s as if they just don’t have adequate communication in their blood,” says František Schneiberg, head of the Social Medicine and Public Healthcare Department at Charles University.
After visiting a pediatric department at a hospital in Germany, Schneiberg says he was surprised by how much time one doctor spent with a child. “I could not believe it took a pediatrician three hours to admit a child,” he says. “First, he started playing with the kid, talking to him, gaining his trust. Only after that did the doctor ask the child to take his shirt off in order to examine him.”
But Schneiberg stresses that money is a big part of the reason doctors in the West are able to spend more time with patients. “While for a German doctor it is enough to have two patients a day, a Czech doctor has to have 20 patients a day if he wants to survive. Doctors here are overloaded with work,” Schneider adds.
Others agree. “I am not surprised that older doctors are sometimes grumpy. To work for 25,000 Kč [$1,204] a month after 30 years is slavery,” says Jan Bafrnec, a medical student.
Bafrnec’s girlfriend, Sara Figueira, a Portuguese medical student at Charles University, sees some similarities with her home country. But the differences outweigh them, she says.
“Patients here are afraid to ask questions,” Figueira says. “In Portugal, doctors would often rather keep quiet but patients ask all the time and want to know the details.”
As for Caroline, she welcomes the idea of communications training. “It is not about the professionalism and level of care — that was always excellent. It is about the inability to take the patient’s feelings into account.”

Jana Donovan can be reached at news@praguepost.com


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