Thomas got an early lesson in what not to do. He was a medical student and had just watched a woman die on the operating table after a car accident. The surgeon appeared in the waiting area, said "she didn't make it" and walked away.

"He should've sat down, taken a deep breath and described in detail what happened," Thomas says. "He should have let the family know that she wasn't in pain when she died, that she wasn't afraid. Then, he should have said he'd answer every question they had."

Thomas believes the difficulty will grow as baby boomers reach old age and bad medical news grows more common. "We better get good at this," he said.

Patients and family members who have found their time-strapped doctors to be brusque or indifferent say the experience can compound their frustration or anger.

Michael Bennett, president of the Coalition for Patients' Rights, an advocacy group based in Maryland, says his bad experience with five Baltimore hospitals several years ago spurred him to join the coalition. He argues that doctors actually communicate less with patients than in past decades, something he attributes to an excessive fear of malpractice lawsuits.

"My dad went in with a respiratory virus that was becoming pneumonia," he says. "What should have been a three-day hospitalization turned into four months of unmitigated torture," Other than a call from one doctor, he didn't get "a single phone call, conversation, nothing, not a word."

At Johns Hopkins, medical students begin learning how to interact with patients right away. Twice a week over the first four months, they do role-playing with actors called "standardized patients."

Put simply, better doctor-patient interaction is better for patients, says Dr. Patricia Thomas, associate dean for curriculum at the School of Medicine and no relation to Bill Thomas.

Thomas recalls the time decades ago when, during her internship, she had to tell a Spanish-speaking woman that her husband's advanced lung cancer had taken his life. Though expected, the news, delivered through a translator, sent the woman screaming, thrashing and collapsing into relatives. It was the most emotional response Thomas had ever witnessed, and to this day she wonders if it was what she said, or how she said it.

Thomas also remembers the case of a middle-aged patient who was admitted with pneumonia and then suffered a heart attack that left her unconscious with evidence of serious brain injury. It fell to Thomas to tell the woman's family that she'd probably never wake up.

Each time she saw the family over the next few days, they peppered her with questions. Could their loved one hear them? Could she sense their touch? Thomas acknowledged she didn't know but encouraged them to trust their faith.

Eventually the family decided to turn off life support. Afterward, Thomas cried with them. To her surprise, they all hugged and thanked her, "in essence for my failure to cure their wife and mother."

Such exchanges are far more common than misunderstandings or emotional outbursts, says Duncan, the Bayview surgeon. Trouble is more likely in trauma situations, when a surgeon hasn't had time to build rapport with the patient or family. Sometimes he tries to have a nurse or another doctor at his side to avoid the chance of a one-on-one dispute.

The good news, Duncan says, is that the medical community has come a long way in recognizing the importance of communication with patients.

"It's easy to get excited about a six-hour surgery with all kinds of technical wizardry," Duncan says he tells young medical residents. "But lending comfort and understanding to someone who is not going to be cured is a tremendous opportunity to deliver care."

childs.walker@baltsun.com

scott.calvert@baltsun.com

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