Annual 2005
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Annual 2005
On Bedside Manner
Does your doctor have people skills? Cathy Cassinos-Ca
Finding a doctor with a great bedside manner is like looking for love: You have to kiss a lot of toads before you find the prince.
“Most of my prior experiences with doctors were not that good,” says Jeanne Huggins, who thinks the world of her personal physician of 10-plus years, Stanley Chew, M.D. “They would interrupt me as I was describing my symptoms, or start writing a prescription before I’d even finished talking. Some of them didn’t even maintain eye contact.”
But Dr. Chew is just the opposite, says the 60-year-old Huggins, a Rancho Cordova resident. “Of course bedside manner is not as important as a correct diagnosis or the correct course of treatment,” she says. “But I would say it comes up a solid third after the other two.” Listening skills are especially important, says Huggins, and she’s not alone: A 2004 Harris Interactive poll of 2,267 U.S. adults showed that patients put a higher priority on being listened to than they do about their doctors being up-to-date on current medical research and treatment.
And lest you think this is about needy patients wanting a double dose of attention, think again: As Huggins points out, good listening skills are key to good doctoring. “If doctors don’t listen well, it’s too easy, to my way of thinking, for them to miss things,” she says. “Dr. Chew is both an excellent listener and an excellent diagnostician, and I think one has everything to do with the other.”
Bedside Manner: What’s Being Done?
While “bedside manner”—aka people skills—is arguably more difficult to nurture and sustain in an era of managed care and shorter patient visits, it is heartening to know that new efforts are being made to promote it. Just last year, a new skills test on personal interaction and communication was added to the U.S. Medical Licensing Examination, requiring all medical students to be observed and graded on their interactions with simulated patients. And on a local level, several of the region’s major medical groups—Kaiser Permanente, UC Davis Medical Center and Sutter Health—are doing their part by offering in-house classes and workshops designed to help their providers brush up on their bedside manners.
Not all providers are keen on such training, but at UC Davis, they have no choice: All staff doctors and nurses are required to complete a four-and-1/2-hour patient-clinician communication workshop. “I like to compare it to what coaches do for professional athletes,” says Alan Brooker, D.O., and UCD’s medical director of managed care, who spearheaded the effort. “From the beginning intern to the bedside nurse to the practicing physician, none could get where they are without good communication skills.” In the UCD workshop, providers learn the importance of the four E’s of communication—engage, empathize, educate and enlist. “The workshop helps to remind health care practitioners that communication is an essential part of health care, and can’t be delegated—everybody’s responsible for it,” says Brooker. “And number two, communication is a skill, and like any skill that any health practitioner has, it can be improved with practice.” Some 800 nurses and 600 physicians have received the training since UCD launched its program in late 2003.
At Kaiser Permanente, all 5,000 of its Northern California physicians recently completed a “personalizing our care” course, which, similar to UCD’s program, introduces a four-pronged approach to better communication skills. "The ‘four-habits model’ that we teach our physicians has been the industry standard for some time now," says John Chuck, M.D., assistant chief of medicine for the North Sacramento Valley. Integrating technology into the patient care experience was also part of the coursework. Kaiser places a premium on a physician’s bedside manner and communication skills, says Chuck, "because it sets the table for great patient-physician communication, which is probably the best predictor of quality and service." Patient-physician interaction classes and formal mentoring programs are offered at Kaiser on an ongoing basis.
But while such continuing education efforts are to be commended, the initial responsibility rests with medical schools, notes David Gallagher, M.D., Sutter Medical Group hospitalist director. “Too often, medical schools are going after applicants with 4.0 grade averages who have terrible interpersonal skills,” he says. And while an increasing number of schools offer curricula to teach future physicians the art of bedside manner, there is still a long road ahead, says Gallagher. “The greatest challenge will be overcoming the traditional training in which future doctors are taught to make it through the day as quickly as possible, with patients often viewed as obstacles,” he says.
Beyond Training
But there is more to the story than training, notes Jay Owens, M.D., a surgical oncologist for Sutter Medical Group. Like anything else, he says, bedside manner is a skill that improves—theoretically, anyway—with age and experience.
“Bedside manner doesn’t evolve right off the bat,” says Owens, who remembers his own bouts of insecurity and lack of confidence when he started practicing medicine in Sacramento 21 years ago. “When you’re new at your job, you’re dealing with new problems you’re not sure you can solve, so there’s a lot of pressure. But as you get older, you’re more confident that you have the skills to manage the disease, so you’re better equipped to manage the patient as a person.”
Personality is also a factor, adds Terri Fox, RNP, MSN, a longtime veteran of hospital nursing who now serves as a school nurse for Sacramento City Unified School District. “I think bedside manner is part personality, and partly an art that the provider develops as they practice medicine,” she says. While communication skills training in nursing or medical school would be “excellent,” says Fox, “it won’t necessarily guarantee a generation of providers with good bedside manner.”
Patient Satisfaction: Key to Success
Because good bedside manner leads to happier patients—and happier patients are more loyal patients—it is in the best interest of all health-care providers to cultivate it, notes UCD’s Brooker. “By reviewing our patient satisfaction surveys and our contracts with the health plans, it began to seem that there was going to be a tie-in between reimbursement and patient satisfaction,” he says. That realization—and the research that shows good communication skills improve the quality of care—helped to drive UCD’s decision to create and mandate its patient-clinician communication workshop.
At Sutter, patient satisfaction rates have soared since the medical group has placed more emphasis on bedside manner, says Gallagher. “We emphasize spending more time with patients, scheduling daily family meetings [by phone or in person] with elderly patients’ families, not interrupting when patients or families talk, and a number of other techniques,” he says.
Bedside manner is also one of the main qualities he looks for when recruiting new physicians at Kaiser Permanente, says Chuck. “We always look for people who are intellectually and academically qualified, of course,” he says. “But beyond that, the key is looking for physicians who have strong interpersonal skills and bedside manner.”
Patients assume their doctors are smart and that their medical skills are good, says Chuck, but what they’re really looking for is service. “What service means is: Is it easy to get an appointment? Did your doctor communicate well with you? Did they communicate that they really care about you as a person? Did they close the loop? That’s all really part of bedside manner and interpersonal skills.” Being a good listener is crucial, adds Chuck. “I’ve always put a big emphasis on being a good listener,” he says. “I think the world needs more good listeners.”
The Patient’s Role
Without a doubt, having a doctor who listens and communicates well sounds like nirvana. But since communication is a two-way street, isn’t there anything patients can do improve the flow?
“Writing down questions helps,” offers Gallagher. “For our elderly patients, having a family member or friend present who can reinforce and repeat what was said after the interaction helps, too.”
“Communication is definitely a two-way street,” agrees Chuck, “and I think patients will definitely get more out of the interaction if they come prepared. Just as the doctors need to be prepared for the visit, it helps if the patients are too.”
Still, Chuck is a firm believer that when it comes to positive and productive provider-patient interactions, the ultimate responsibility lies with the provider. “As physicians and health-care providers, we understand that most patients who come to us are either sick, or expecting to be sick, so we can’t really expect them to be on their best behavior,” he says. “They’re paying us to serve them, so it’s our job to lead the way.”
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