Mary Elizabeth Williams

Listen up, doctors: Here’s how to talk to your patients

Patients need compassion and dignity, but too many doctors act like mechanics. Here's how we'd like them to behave

  • more
    • All Share Services

Listen up, doctors: Here's how to talk to your patients (Credit: Everett Collection via Shutterstock)

My doctor always walks into the exam room smiling. It’s not necessarily the countenance you’d expect from a man who spends much of his time working with people with Stage 3 and Stage 4 cancers — the kind that haven’t responded to other forms of treatment. Yet even when we speak on the phone, I sometimes swear I can hear him smiling. Granted, I’ve given my doctor something to smile about – I’ve been doing spectacularly well in my Phase I trial, delivering CT scan results that he appreciatively refers to as “neat.” Yet the extraordinary thing about my doctor is that he was smiling the day I met him, when I was facing a diagnosis that put my long-term odds of survival in the “probably not going to happen” range. And from that first grin, he deflated my terror and made me believe I was in the hands of someone not just invested in my wellness, but downright optimistic about it.

A natively cheerful demeanor isn’t a requirement for being a competent healer. But what is far too often lost in our grueling, impersonal and cost-driven healthcare system is the basic fact that a human being in the chaotic and scary world of injury or illness deserves sensitivity and compassion. That a shivering person in a paper dress deserves dignity. So if you’re a doctor, nurse or technician, here’s your reminder. And if you’ve ever been a patient, we’d love to read your own additions to the list.

Take your hand off the goddamn doorknob already.

We know you are incredibly busy and important and that your office has wildly overbooked your schedule today. You know what, though? It’s not our job to streamline your day. Conveying information while you’re walking out the door may work if you’re a character on “Revenge,” but it’s a crummy way to have a conversation with a person about his or her health. We just sat out in the waiting room for 45 minutes reading last week’s hype-trolling issue of Time magazine; we’ve sat here in a robe for a half-hour looking at the pain assessment chart. Now you can at least pretend to give us your full attention for the five minutes you’re prodding our vulnerable, unclad bodies. You’ll immediately rise in our esteem.

Dr. Carma Bylund, director of the CommSkil program at Memorial Sloan-Kettering, notes that studies have shown that “when a doctor comes into the room and sits down with the patient, the patient perceives the visit as longer. The doctors are at eye level; they’re attentive — and they can’t put a hand on the doorknob.”

Remember that this random collection of faulty parts is a person.

At a Times talk last winter, Will Reiser, the writer of “50/50,” admitted he’d loosely based the poker-faced oncologist of the film on his own doctor, referring to him as “a mechanic” who saw him as the car he had to fix. It was a generous assessment of clinical sangfroid, one that acknowledged that nobody wants a doctor who’s lacking in the professional boundaries department. But that doesn’t mean you should let yourself turn into a robot.

Early in my treatment, I had a doctor on my clinical trial bring in a team of research fellows to look at “the tumor.” That the tumor had a sentient human host seemed utterly irrelevant to him. And when my friend Ariel had a miscarriage, the sonogram technician confirmed it by briskly announcing, “Yup, no heartbeat,” and walking out of the room. This is what is known, in medical terms, as a nightmare.

You may deal in tumors and miscarriages in a revolving door of horrible things all day long, but your patients live in a very different world. Their tumors and miscarriages and dying parents are pretty important to them. The moment they become trivial to you, seriously rethink why you ever wanted to do this for a living.

Consider that the patient is telling you something the charts don’t.

“I had one endocrinologist clearly point out during my exam all of the physical characteristics that lead him to believe I was hypothyroid and had adrenal function issues,” says my friend Alice. “He pointed out stretch marks (without childbirth). He pointed out dry skin. He pointed out my premature gray hair (specifically a prevalent streak near my forehead). My weight gain and inability to lose weight. Quite a few other characteristics. But the lab tests came back ‘normal’ and that is literally what he offered me. ‘Your tests say normal so there is nothing wrong.’” Can you understand why Alice was exasperated?

Most of us truly get it that doctors don’t know everything. We don’t expect all-seeing miracle workers. And we understand that some patients are either incapable of giving accurate information or are just plain wrong about what they believe they have. But a person who is suffering, who is symptomatic, is entitled to a fair and thorough investigation – and if you can’t provide it, please, suggest somebody who can. Don’t shrug off pain with a blasé suggestion of Tylenol or cutting out dairy and not even look at the person. Instead, be like the doctor who once told me, “There’s always something more we can do for a patient.” Do something more.

Accept that we didn’t go to medical school

You know how you’re rattling off protocols and surgery plans and fancy words for body parts we didn’t even know we had? Whoa whoa whoa – slow down there, partner. You’re talking to someone who may not know a colostomy from a semicolon. Your rapid-fire delivery is intimidating and scary. It makes us feel stupid and bothersome, like we should know all this stuff and not ask questions.

“Doctors forget that the minute a patient hears bad news or that there’s a problem, patients stop listening,” says my doctor friend Joe. “Or if they hear anything, they’re hearing incomplete info. The onus then is on us to find ways to help patients understand what just happened, whether it’s writing down instructions, calling a patient later in the day after the dust settles, or simply asking a patient to repeat something back.”

“Healthcare providers often have a kind of script,” adds Dr. Bylund. “They may have certain things they may always say to everybody. We teach doctors to check patients’ understanding and use that to tailor consultation to the person’s needs. Say things like, ‘Tell me what you know about your disease,’ or ‘Tell me what your last doctor said.’ And we show them how people’s past experiences may impact their choices now.” Maybe we don’t know anything about Parkinson’s. Maybe we know a harrowing amount because of what Mom went through, and we’re frightened to death of it. Start with what we know before you dump everything you know on us.

Leah Berkenwald, a health communication student and writer, says, “What good is the diagnosis or treatment if a patient cannot understand it or follow instructions? What is often deemed noncompliance is often a result of a failure to communicate.” And, she says, “It doesn’t matter how good a physician is at diagnosis or treatment if the patient doesn’t understand what they’re supposed to do, how to do it, or why it matters. Medical knowledge and clinical skill become moot when a physician makes assumptions about their patients’ cultural values, beliefs and practices.”

Talk frankly about how we’ll pay for this – and don’t assume anything

As Salon reader Lila says, “The calculation about what choices are available to me seems to be made before I hear the medical advice … Don’t get me wrong, it can be tricky for individuals to figure out how to afford healthcare, and I’m glad for healthcare professionals’ sensitivity to that. But when my husband was being sent home from the hospital — too early, we felt — a problem came to light: The doctor finally said she too felt it was too early but said the insurance wouldn’t pay another day. In fact she was wrong (and the insurance ultimately did pay another day), but more problematic is that she made a decision to discharge based upon something other than medical reasons — and we didn’t know that was happening.”

Nobody – on either the medical or patient end – wants to get walloped with a contentious bill. So talk to us so we can work together to get the most care for the buck. Don’t treat us like dirtbags if we’re out of network or uninsured, either; work with us to find other options. And you can pass that tidbit on to your office staff. Imagine what it feels like to be both sick and poor — now imagine what it’s like to add “demeaned” to your list of problems.

All of us, even the strongest among us, find ourselves on the business end of the stethoscope sometimes. And though it seems pretty basic, I’ll let a real doctor say it so you take it seriously: “Ultimately, health and wellness have a lot to do with the comfort a patient has with a doctor. You’ll give better information when you have a doctor who makes you feel secure,” says Dr. Bylund. When you’re compassionate to us, we’ll show up for our checkups. We’ll be honest about conditions and circumstances, because we aren’t afraid of being shamed or judged. We’ll still put our faith in science, and accept that pain and sickness are sometimes unavoidable. But we’ll be less scared when we walk through those very scary doors. And though we’ll do our best to ward off disease, we’ll gladly submit to something infectious – the power of being decent, and your faith in us.

It’s time for Dharun Ravi to apologize

Tyler Clementi's roommate gets a month of jail time in the Rutgers intimidation case. Will he ever say "sorry"?

  • more
    • All Share Services

It's time for Dharun Ravi to apologizeDharun Ravi (Credit: AP/John Munson)

Tyler Clementi’s mother calls his actions “evil and malicious.” His father says they were “the cold-hearted violations” of his son, who committed suicide in September 2010. And a young man known only as “M.B.” said in a written statement that he “caused me a great deal of pain.” So, does Dharun Ravi’s punishment — 30 days jail time, 300 hours of community service, three years’ probation, and $11,900 total in fines — fit the crimes of which he’s been found guilty?

In March, Ravi was convicted of charges of bias and intimidation stemming from the death of Clementi, his Rutgers roommate, whom he had secretly filmed, in Ravi’s words, “making out with a dude.” It was a story that reverberated around the world, and helped invigorate the anti-bullying movement. As Judge Glenn Berman handed down the sentence Monday afternoon, calling Ravi’s actions “offensive and unconscionable,” he said that he would not recommend deportation. But the judge did pointedly tell Ravi, “I haven’t heard you apologize once” for his callous behavior. And he said he made “no comment” regarding any further civil actions the Clementis might take.

Though Berman said he believed the sentence “disenchanted both sides,” it’s one that shows respect for the law as it stands in New Jersey. It also offers what Berman calls the “hopeful” possibility that Ravi — and others who have so cavalierly shamed and exploited people — might learn something about the quality of mercy. Maybe all those hours of service can teach Ravi something he, as an 18-year-old college freshman, was so devastatingly lacking.

In her remarks to the court Monday, Clementi’s mother tearfully said that a piece of her died when her child killed himself. And M.B., the anonymous young man whom Ravi secretly recorded with Clementi in September 2010, said in a statement to the court that while he bore Ravi no malice, he “just wanted him to acknowledge that he had done wrong and take responsibility for his conduct.” That atonement isn’t something a judge can impose. And it’s a statement Ravi has yet to make.

Continue Reading Close

As Kristen Wiig departs “SNL,” what’s next for women?

"Saturday Night Live" says goodbye to a star -- and leaves late night without a queen

  • more
    • All Share Services

As Kristen Wiig departs Mick Jagger and Kristen Wiig during the season finale of "Saturday Night Live"

What, you didn’t get to dance with Mick Jagger, hug Jon Hamm and be serenaded by Arcade Fire the last time you left a job? I guess you’re not Kristen Wiig.

After seven years on “SNL,” Wiig said goodbye on Saturday night’s season finale that will go down as one of the sweetest, most choked-up moments on the show since Steve Martin said goodbye to Gilda Radner on the day of her death almost exactly 23 years earlier.

Even without an official announcement, Wiig’s twirly, teary departure is enough to make even the most casual fans of the show crank up the Adele and mainline a tub of Edy’s Grand. It doesn’t matter that fellow castmates Andy Samberg and Jason Sudeikis have reportedly moved on from the show as well. They leave behind established male cast members like Seth Meyers, Fred Armisen and Bill Hader. Wiig, on the other hand, blows a gaping hole in the show’s female lineup. The 24-year-old Abby Elliott, who moves up the rung to the show’s senior lady cast member, is now its biggest female star. But she’s yet to display that versatility or command the clout that Wiig has. Kate McKinnon may yet bust out into full-blown “SNL” stardom, but she’s only been on the show for five minutes.

And so, after years of cultivating a stunning roster of formidable female talent — Tina Fey, Maya Rudolph, Amy Poehler and Wiig — the show is, for the moment anyway, back to a state of relative desolation it hasn’t seen since the ’90s, an era that reached its nadir when Janeane Garofalo bailed midseason. It’s a strange, disconnected moment for “SNL,” right as women are making grand enough strides in television and film comedy that we’ve magically attained “labia saturation.” And though Wiig will no doubt continue to dominate in movies as a writer and performer, it’s sad that she leaves behind no true heirs on a show that, especially in an election year, remains so influential.

Visibly emotional and flanked by current cast members as well as the likes of Chris Kattan, Rachel Dratch, Steve Martin and Chris Parnell, and an especially rollicking Amy Poehler, new alumna Wiig didn’t depart “SNL” alone. She took with her Gilly,  the tiny-handed Judice,  Target Lady, Suze Orman and even Tan Mom. Why were so many people red-eyed on Saturday? Because on the stage that night stood a woman with incredibly big shoes to fill – and one very small hat.

Continue Reading Close

When the school is the bully

A middle-school family gets a lesson in Facebook privacy

  • more
    • All Share Services

When the school is the bully (Credit: Goodluz via Shutterstock)

In a world that still asks women if they’re “mom enough” and debates our “obsession” with our children, Pam Broviak this week showed us what an awesome mom looks like.

Last fall, Broviak says, her 13-year-old daughter’s suburban Chicago school forced her to let them access her Facebook account and scour her private information, a policy Broviak says is commonplace in the Geneva Middle School South. In a blog post in April, Broviak added that when the incident happened, “the vice principal called me to demand I come to the school immediately to read through [my daughter's] private messages.”

Broviak told MSNBC Friday, “What a violation of my daughter’s privacy this whole episode was,” adding that the experience took “a huge toll on my daughter, who ended up crying through most of the rest of the day and therefore missed most of her classes. She was embarrassed and very upset.” She says when she confronted the school about the issue, they told her it was routine policy to investigate students’ social networking pages and cellphones.

Geneva schools superintendent Kent Mutchler told MSNBC Friday that Broviak’s version of events is inaccurate, stating, “We would never demand someone’s password. When you have someone’s password, you open yourself up to other issues.” But alarmingly, he added, “If we have a disruptive situation, a school [official] will ask to see the page, and if the student refuses, we call the parents … There are different levels of concern. If there is a drug trafficking suspicion, we’ll get the police involved. If it’s something like cyberbullying, we’ll say, ‘This has been reported to us,’ and ask to see the page. We ask, ‘Is there something you want to show us?’ that sort of thing. And they volunteer.”

Oh, they just up and volunteer? Let’s think about this a minute. You’re a 13-year-old. It’s implied you’re in trouble for something, and your teacher or principal suggests that if you have nothing to hide, why wouldn’t you share what you’ve been doing online? That’s a fantastically intimidating and pathetic abuse of power, wielded against the kids you’re daily teaching to comply to your requests.

And, as Broviak points out, that kind of behavior isn’t just a violation of the student’s privacy –  but that of anyone in her social media circle. “Some families communicate through Facebook,” Broviak told MSNBC. “What if her aunt was going through a divorce or had an illness? And now there’s these anonymous people reading through this information.”

Sadly, this kind of repulsive invasion isn’t an isolated incident. Last month, Garrett, Ind., high school student Austin Carroll was expelled for using profanity on Twitter. And, mind-bogglingly enough, earlier this month 4,000 New Jersey third-graders were asked “to write about a secret and why it was hard to keep” on a standardized test.

Schools are — not without justification — scared witless about the ease with which kids commit all kinds of wrongs via social media. They’re concerned about how they interact, and the consequences of their communications. Great. But that doesn’t mean ignoring the basic fact that kids are entitled to privacy, too. They’re entitled to complain about their homework load; they’re entitled to post silly pictures of themselves; they’re entitled, in short, to express themselves on their own turf in their own terms. Sometimes that notion that kids are out there behaving in ways we’re not privy to can be terrifying for adults. Tough. How about working with them to include empathy and conflict resolution in the curriculum, instead of cracking down on their extracurricular lives? How about talking to them? Because snooping around in people’s private lives, coercing them into compromising behavior – it’s called bullying. And isn’t there already enough of that in our schools?

Continue Reading Close

HGTV: Winning the war for gay marriage

For nearly 20 years, one network has redefined domestic bliss -- and taught Americans to love their neighbors

  • more
    • All Share Services

HGTV: Winning the war for gay marriage (Credit: Karina Kononenko via Shutterstock)

There are two ways to bring about positive, long-term social change: the fast one and the slow one. In the first version, statues are toppled, walls are torn down, laws are dramatically enacted. There is, forever, a clear before and after. It’s days like July 24, 2011, when New York state approved same-sex marriage. Or May 9, 2012, when Barack Obama became the first president to announce his support for the issue — an occasion that prompted incoming Human Rights Campaign president Chad Griffin to remark, “You will not forget where you were when you saw the president deliver those remarks.”

Then there’s the subtler version. The kind where you look around one day and suddenly realize that gay people have been building families and creating homes together this whole time. They’re your neighbors. They’re your fellow parents on the PTA. And they are totally the couple building an amazing new deck this weekend. For 18 years now, HGTV has been a steadfast force for exactly that kind of tolerance, simply by advancing the radical notion that homosexuals are out there in the world obtaining mortgages and painting their interiors just like straight people.

It’s not that LGBT-friendly content doesn’t exist elsewhere on television. I mean, Christ, have you ever seen Bravo? We could start with Andy Cohen and not even get around to “Project Runway” for days. There are entire gay-oriented networks, like Logo. But what distinguishes HGTV is both its durability and its ordinariness.

HGTV doesn’t trade in drama or high camp; it doesn’t offer “Wig Parties and Threesomes” stereotypes. Sure, one might suggest that the network’s high population of flamboyant gay designers panders to a different kind of typecasting. But the presence of hosts like David Bromstad and the married, father of two Vern Yip seems more like a logical, ordinary reflection of the makeup of the field. It’s also likely why there are so many gay contestants on its competitions as well. Just look at last year’s “Design Star” combatants, which included the lesbian former Dallas Cowboys cheerleader (and mother of four) Leslie Ezelle, and “average gay dad” Tyler Wisler.

More significant than its regular on-air talent pool, however, is the network’s consistent depiction of America’s gay and lesbian population as normal, carpooling, Home Depot-shopping folks whose agenda includes upgrading the kitchen backsplash. Far from the cavalcade of dysfunction on networks like TLC, the network regularly presents typical families of different ages and ethnicities — some of whom happen to be same-sex — on shows like “Property Virgins” and “House Hunters,” where the most shocking element of an odyssey is likely to be the property’s price tag.

That a network built around design would position itself as gay-friendly might seem like a no-brainer. But it’s also a network that  still has an overwhelmingly female core audience that isn’t necessarily going to identify with male same-sex couples. But by depicting a variety of couples and families, the Scripps-owned empire is broadening its base and appealing to a wider demographic. It’s also reflecting the reality of contemporary America.  As “Property Virgins” casting director Michael Barrick said when he put out the call for Atlanta-area LGBT parents last month, “I do prefer to see as diverse a population featured on television as possible. People like to watch a show that they can relate with, be it black, white, Asian, interracial, gay and straight. If they don’t see that representation, they are more likely to change the channel – and that is something as a casting director, that I just don’t want to see.”

There are still plenty of people out there stuck with antiquated ideals. Some of them are even running for president. But the fact that the American family doesn’t always resemble an Eisenhower-era sitcom is something more and more of us accept. It’s been a long time coming and it’s still a work in progress, but our American image of home and family is, in the words of the president, evolving. It evolves when a law is changed or a leader speaks out. And it evolves when two guys buy a house together on basic cable, and then another two, and another two, and the two ladies. Suddenly it’s not weird or unique or groundbreaking at all. It’s improvement. One home at a time.

Continue Reading Close

Manny Pacquiao loses his crown

The boxer's anti-gay remarks lead us to take an unprecedented step: We're revoking his Salon Sexiest Man title

  • more
    • All Share Services

Manny Pacquiao loses his crownSteve Carell and Manny Pacquiao (Credit: AP)

We’re all relieved around here that Manny Pacquiao is not really some Leviticus-quoting loon who says that gays “must be put to death” – even if that may have something to do with the fact that he admits “I haven’t read the Book of Leviticus yet.”

But it’s nonetheless disappointing that a man we at Salon bestowed our highest honor to just six months ago has proven himself so terribly unenlightened. In an interview for Examiner.com last week, one of our 2011 Sexiest Men declared of marriage, “It should not be of the same sex so as to adulterate the altar of matrimony, like in the days of Sodom and Gomorrah of Old.” Oh dear. Winning lots of fights? Sexy. Getting elected to the Filipino Congress? Sexy. “Donating millions to improve living conditions in his poverty-stricken nation”? Super hot. Not being down with civil rights? Bzzzzzzt!

That is why we have decided to take an unprecedented step here at Sexiest Men World Headquarters. We have in the past fought epic, bloody internal battles over men like Zach Galifianakis, Al Franken and Louis C.K. But we have never, in our sexy, sexy history, revoked a man’s title. Until now.

We understand that the Roman Catholic boxer has to be true to his beliefs, and we would never insist that falling in lock step with Salon’s own socialist, American fabric-destroying agenda is the only criterion for making the list. It’s just that we suddenly don’t feel like going a few sweaty rounds with a dude who thinks civil rights “adulterate the altar of matrimony.”

So instead we’re passing on the crown to one of last year’s runner-ups. Like Pacquiao — and also like our beloved first Sexiest Man, Carell’s former “Daily Show” colleague Stephen Colbert – he’s a happily married, self-described “born and bred” Catholic. But this one says, “I stay clear of declaring my political choices,” insisting humbly, “I feel like my voice is no more valuable, no less valuable than anyone else’s.”

What really makes us go weak in the knees is how he turned a bumbling, inept bag-of-wind character and made us care when he said goodbye to “The Office.” And, last summer, he took a broken, pathetic, recently divorced dad and made him so tenderly romantic (and so darn good-looking in a tailored suit) he nearly made us forget Ryan Gosling in “Crazy, Stupid Love.” We’ve had a thing for him since before he became a 40-year-old virgin. We’d choose him as our friend for the end of the world. How could we ever have been so blinded by that pugilistic piece of beefcake? That’s why today, we’re asking newest Salon Sexy Man Steve Carell, will you gay marry us?

Continue Reading Close

Page 2 of 208 in Mary Elizabeth Williams