Bedside manner matters

While every patient hopes to be seen by a doctor with the perfect combination of diagnostic skills and empathy, good bedside manner is not always a given, especially as doctors become increasingly pressed for time, bogged down in files health electronics, focused on care coordination, and pressured to reach the patient in the next room.

“We’ve noticed that there are certain types of doctors who are very smart but don’t have that communication connection with patients,” said Errol Ozdalga, MD, assistant professor of medicine and director of Stanford Medicine 25, a program at Stanford University. School of Medicine, Stanford, California, led by Abraham Verghese, MD, who teaches and promotes bedside examination skills.

says Verghese Medscape Medical News that some doctors are terribly emotionally intelligent, but not so technically good. “When I see a doctor with both qualities, I consider it a double threat.”

Because bedside manners can be subjective, the definition of what constitutes the best is unique to each doctor—and that’s something that usually comes up immediately in online reviews. And it’s the first thing patients complain about in negative reviews.

For Michael Cameron, MD, a dermatologist in private practice in New York City and assistant clinical professor in the Department of Dermatology at Mount Sinai Health System, having good bedside manner means treating patients the same way you treat members. his family.

“Patients want to feel comfortable around their provider, so one way I do that is to try to get to know them as human beings, not just patients,” Cameron said. “I try to convey confidence as well as approachability.”

Bedside manner = confidence

Good bedside manner is essential because empathic listening allows doctors to establish a relationship of trust and confidence, said Nayan K. Kothari, MD, chief academic officer at Saint Peter’s University Hospital in New Brunswick, New Jersey. “Not having proper bedside manner increases the likelihood of mistrust, ordering unnecessary tests and consultations for the doctor, which then negatively affects the patient’s well-being.”

To this end, Saint Peter’s has developed a robust curriculum called the Advanced Medical Examination and Communication Course, a 2-hour-per-week course that runs over 50 weeks.

“This covers two of the most important aspects of being a doctor,” Kothari said, adding that the course includes a didactic presentation, a practicum in which a real patient with real physical exam results is brought into the classroom for an interview. The course concludes with a final exam created in collaboration with the Royal College of Physicians in London, England.

The art of talking to patients

For Stanford’s Ozdalga, helping medical students hone their communication skills was personally fulfilling.

“I teach medical students that there’s an art to talking to people, being sensitive about what you’re hearing, and making sure you care about their agenda — not just your own.”

Although communication is one of the six core competencies in medical education, medical students have historically been taught to focus more on the mechanics of taking a history and performing a physical exam.

“While medical schools highlight the questions you should ask, the exams the person needs and a list of questions, you learn a lot more through observation and listening—which is what we focus on in our course,” Ozdalga said .

Taking the time to connect with a patient can be difficult given the challenges that exist in health care today, said Lisa Howley, PhD, senior director for medical education transformation at the Association of American Medical Colleges.

“Short patient appointments and staffing issues are certainly barriers that are systemic and make it difficult to spend quality time or provide the resources and support that would be ideal,” Howley said. “The solution is not an easy one.”

At Saint Peter, the mission is tactical as the goal is to alleviate some of the problems that arise from poor communication with patients.

“One of the challenges facing physicians today is insufficient education in bedside manners,” Kothari said, adding that this leads to a shallow history, limited physical examination and poor differential diagnosis decisions. “This in turn has led to excessive and unnecessary testing, creates patient dissatisfaction and increases the risk of litigation.”

Increase your emotional intelligence

It’s one more reason why Stephen Berns, MD, associate professor in the Division of Palliative Medicine at the University of Vermont’s Larner College of Medicine, Burlington, Vermont, is pleased that over the past 5 years, medical school admissions assessments have have become more focused on an applicant’s emotional intelligence as well as medical school entrance exam scores.

“Medical schools look for someone’s emotional capacity and empathy over how many papers they’ve published,” Berns said. “Since this started happening, we’ve seen a difference in the skill set our students bring to patient-centered care.”

Responding directly to a patient’s emotions can also make all the difference.

“We’ve seen anecdotally that if you don’t respond when a patient has an emotional reaction, they won’t hear what you’re saying,” Berns said. “Let’s say we shared some breaking news that a patient’s cancer has come back, and the first thing they say is, ‘Can you rerun the test?’ We’re trained to answer the question, but if instead of saying you can’t, you say, “I see that’s surprising news to hear,” you acknowledge their emotion and that can move the conversation along in some way. better direction.”

Ultimately, good bedside manner simply boils down to thinking about what it’s like to be on the other side of the exam table—every time you walk into the room and meet a new or existing patient.

“I’ve been on the other side and had to advocate for my loved ones, so I was able to observe the good and the bad among doctors,” Cameron said. “While you don’t have to have been a patient to have empathy, it’s something every healthcare provider should think about.”

Lambeth Hochwald is a New York-based journalist covering health, relationships, trends and issues important to women. He is also a longtime professor at NYU’s Arthur L. Carter Journalism Institute.