I've written previously in this space about the need for physicians, nurses and other hospital staff to show more compassion when dealing with their patients. While that might bring to mind the warm and fuzzy image of Marcus Welby, M.D., a few readers point out that the most compassionate care can sometimes involve a kind of tough love. Here are excerpts from three of those responses.


Carolyn, R.N.:
"I agree that too many people working in hospitals, both at the bedside and elsewhere, give patients the impression of being overly stern, and most of the time they're simply behaving unprofessionally. But occasionally sternness is exactly what's called for. I had an older patient who refused to get out of bed to go to physical therapy. I tried reasoning with her, even bribing her with the promise of something sweet as soon as she returned to her room. Finally I showed her photographs of atrophied legs and told her, 'You have a choice: lay there and feel sorry for yourself and end up in a nursing home or take control of your life, get up and move, and end up back in your own home.' She opted for PT and later sent me a thank you note from home for caring about her enough not to give up on her."

From Roger, M.D.:
"Some people need hand holding and some people need a reality check. When I have a patient who refuses to follow my instructions — whether it be take your medication, abide by your appointments, quit smoking or whatever — I tell them we have a pact that goes both ways. I'll do my part, but if they don't do their's, I'll help them find another physician. I would say that 90 percent of the time, they realize I'm serious and they try to do as told. As long as they are honestly trying, even if they aren't 100 percent successful, I'll keep caring for them. I'll keep encouraging them, too, and that sounds a lot like nagging to some of them."

Gretchen, a patient:
"The first time I saw my doctor for a visit, she was delayed getting to me and I was visibly upset. She apologized and then explained that she has a lot of other and needier patients and that she wants to be able to spend time with them and not rush them. She was very professional but made it clear that if I want to be her patient I have to accept that there may be waits during visits. I couldn't believe she apologized because most doctors don't. Her explanation appealed to me because it wasn't just 'I am a busy doctor and crap happens so deal with it' — it was 'I am in health care because I like to help people and if that means giving them my time, that's what I want to do.' "

Bill Santamour is managing editor of Hospitals & Health Networks magazine. Follow our tweets at www.twitter.com/wsantamour.