Bedside manner


Category : General, Medical Rants

After 30 years of medicine, I have no doubt that bedside manner is the most underrated skill amongst physicians, while highly desired by patients. In my “maturity” I have devoted much more energy to teaching bedside manner. On rounds, when appropriate I have discussions with patients or family about disease, diagnostic tests or prognosis. I do my best to make the patient, and family comfortable during these discussions.

Sometimes I do really well, and sometimes I am not totally satisfied with my “performance”. After each such episode, I convene the students, interns and resident for a “debriefing”. I make them verbalize what I did right and what I could do better. I open myself up to criticism, and generally agree when errors are identified.

I am told that this teaching style is unusual. Perhaps this grant will influence more attending physicians to work on this problem – College gets money to teach bedside manners

A woman who got bad news from a rude doctor has left nearly $2 million dollars for the Medical College of Ohio to teach its students better bedside manners.

New York psychotherapist and Toledo native Ruth Hillebrand died of cancer more than ten years ago. School officials say her doctor called her and told her she had a terminal form of the disease, then hung up on her.

Last week, the Toledo college announced that Hillebrand’s trust had given the largest individual donation in the school’s history. The money will help train students on diagnosing and listening to patients.

The school plans to name its clinical skills center after Hillebrand, whose father was a Toledo-area construction and insurance executive. The facility is to be dedicated next week.

I hope they use the money wisely to develop programs which they can demonstrate lead to improvements.

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Comments (9)

I am not sure there is a program to teach this. There is only one way I think – the way you do it. I commend you for making this a part of your rounds.

There is no program that can teach bedside manner. A good bedside manner is a gift. I’ve seen a lot of good physicians with horrible bedside manners, and then the nursing staff is left to defend how the physician treated the patient. A bedside manner can be coached and then refined. What you can do is teach physicians how to talk to their patients, and talk frankly, in non-medical terms. Mr. Bobby-Lee may not know what an aneurysm is, but if you told him he has a “bleeding/ruptured artery/vein in the brain” he might understand. If they don’t understand, keep trying until you figure out a way they can understand. If you sit and shoot the breeze with your patients for 5 minutes, most the time you can tell how educated they are and how well they will understand the situation they are in. Sometimes not knowing what’s wrong with yourself can be the scariest thing for a patient. Patients count on well educated physicians who can diagnosis what’s wrong with them and help them understand what needs to be done for them. Patients want to feel like: the people that are caring for them care, are well educated, are listening to them and not just their diagnosis, and have THIER best interests in mind. When it boils right down to it, it is one human caring for another. And if that physician is not able to carry on a normal conversation with anyone, let alone their patient, then a profession change is needed for that physician which doesn’t require human interaction. People are assholes, just because you have M.D. after your hole doesn’t change anything.

After almost 50 years in general practice I am disheartened by the callous way in which the “bad news” is now broken to patients by my younger colleagues, specialist or otherwise. The reason, I feel, is the(over)emphasis on “Full disclosure” and “Informed consent.” I hope that when my time comes I shall not be burdened with a greater measure of the truth than I can handle.

Doctors have personalities. Patients have personalities. In the chronic care setting, docs and patients bounce around until a compatible match is found. In acute settings, the possibility of an incompatiblity is much higher. All of us occasionally leave patient encounters with the dreaded feeling that “that did not go well.” It’s not necessary for doctors to beat themselves up over every unsatisfactory encounter. We have to be very careful how we phrase our explanations for legal reasons, and if we do not know the patient well, it can be difficult to determine where on the spectrum a particular patient is. Some want to know everything, and every possible complication (and will sue when an undisclosed complication occurs). Others tune out everything we say, and tell us, “You’re the doctor.” They literally want us to do whatever we think is best for them with no explanation. Even if we get it right with the patient, there will often be different attitudes from the ever present family members. Some docs are better at this than others, but it’s getting harder all the time to meet the expectations that patients place on us. I agree that some MDs are poor at this, and may be better off seeking other lines of work, but often a poor interaction is not the fault of the doctor, and may be due to unrealistic expectations on the part of the patient or family, or nobody’s fault at all. I have been faced with extremely difficult situations, and do my best, but there is simply no way to meet with the patient and family after a “routine” gallbladder operation, to tell them that I found incurable cancer, and have it go well.

As I was walking out of the office, the doctor said, “You know you have MS.”
Not the way to present that diagnosis.

This is such a good issue to be discussed. It’s true, bedside manners are equally important as the knowledge of the medical field itself. After all, doctors work closely with their patients, which is why the issue of good human comunication became a crucial matter here. Hopefully, I’ll be getting more information on latest agenda related to medicine, ethical issues related to it, etc.. I’m really looking forward to gain more knowledge, particularly on the mentioned area. Thanks..

Thinking outside the box for a moment, here is a conversation about patient-physician interaction at Edward Tufte’s site:
the novel suggestion is to ask patients, when possible, to compile a list of concerns and questions while waiting.

Long and Short Of it—I have had two surgeries on my small left finger over 6 years. Now the mass has returned and I need a third surgery. The first surgeon indicated that he lost or the hospital staff lost my tumor. The second surgeon, he is nice but is young and may lack experience. Neither are Board Certified but are Eligible so, due to pain and recurrence, I sought a new surgeons advice. Upon entering the exam room, without Hi or hello, he began to quiz me regarding as to why I “surgeon Shop”. I tried to explain and he became even more antagonistic. My sister that was present, asked him why he was so rude and his reply was “some people don’t hit it off.” I then stated that there was no opportunity to interact–he then said, “I guess I just have a bad bedside manner”. He agreed that I needed another surgery but he would not do it. It was perplexing since I have significant pain from this finger. Also, I have never sued anyone. I remained perplexed by this person and yes, on paper, he has the qualifications to help me. I even began to cry in front of him and my sister–Don’t give him that satisfaction.

bedside manner 101, 201, 301 and 401 should be required courses in all medical schools. one small course each year would be ideal.

it takes a super-geek to make it through medical school. this is good in terms of building technical skill but it can have a desocializing effect on a person.

M.D.s and the medical schools which produce them must emphasize the importance of social skills and the ability to interact with patients on a personal level.

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