Boundaries, respect, culture and personality are all parts of bedside manner. Boundaries and respect are, ideally, reciprocal between physician and patient. I want to project warmth, humanity and concern but I don’t want to burden my patients with my fears, frustration and anger.
During a delivery of a young woman of her first child, she said to me “You look really scared. Are you okay?” I had just found a concerning fetal heart tracing, and my bedside manner was not helpful to her. I quickly tried to rearrange my face.
I am not always successful in reaching my patients. I struggle with my conversations with teenage boys and usually settle for monosyllabic replies.
I suffer and rejoice with my patients and have been known to do the happy dance when a patient quits smoking. Boundaries can be difficult when physician and patient are close and live in a small town. I have been approached in the grocery store to give patients their test results or look at a rash.
During my first pandemic-HIV, I was just beginning as a physician. I was practicing my bedside manner and setting my boundaries. I made many mistakes. Some patients needed home visits and circumstances bent some boundaries.
One of my patients, a delightful young man, had the goal of living on his own before he died. I admitted him with cryptococcal meningitis. He was hallucinating and yet he was still upbeat and hopeful about leaving the hospital. I went to his room to see how he was responding to the antifungal medications, and he told me about his hallucinations and said he really, really needed a hug. This is not usually a big deal and if a patient requests a hug or a prayer, I’m usually comfortable with obliging. However, in his case, he could not sit up and the only way I could hug him was to lie down on his bed beside him. I sat on his bed and held his hand, but he said he needed a hug. I was terrified! What if someone saw me? I would get fired. Maybe, I should get fired. I quickly lay down, hugged him and then jumped up and smoothed out my clothes. No one saw. He recovered and left the hospital and got an apartment before he passed.
I still don’t know if I did the right thing or broke a sacred boundary.
Susan Dirks
Coralville, Iowa