Let me give you an example. What I call the ‘doctorstipsonline. (Cover your ass and order tests). I was in practice in a rural town and one of my patients went to the ER with a headache. She didn’t have vision changes, trauma, migraine-type or neurologic symptoms in fact she really just had a dull pain and tightness in the back of her neck and forehead. She was stressed and it was a tension headache that always responded to either 800mg of ibuprofen or a shot of Toradol (anti-inflammatory). She told the nurse this. She told the doctor this. She told them both her diagnosis and treatment.
Somewhere between 40-55% of patients walking into an ER, primary care office or urgent care center will “tell you the diagnosis.”
She never received any treatment for her tension headache. She received an MRI, blood tests, an EKG and a neurology referral. Communication breakdown = ineffective and unnecessarily costly care. She missed work because she wasn’t treated. This is a total system failure.
There is absolutely no room to share every anecdote like this. Poor bedside manner means poor communication with patients and worse outcomes.
Maybe doctors should just listen to patients. In an analysis of 13 studies by the NORC Center for Research, 59% of Americans were shown to place value on physician-patient relationships and personality with only 11% placing value on accurate diagnosis and treatment. How much time a doctor spends with a patient is very or extremely important to 80% of people. One thing I learned early on was to “sit down and face the patient.” (Pretty basic I know but docs don’t all do this now do they?). This study demonstrated a positive doctor-patient relationship can have statistically significant effects on “hard health outcomes,” including obesity, diabetes, hypertension, asthma, pulmonary infections and osteoarthritis pain. The research looked at studies where doctors were randomly assigned either to provide their normal methods of care or to take additional training or steps to provide more empathetic and patient-focused care. The additional care made a measurable difference in medical outcomes.
I’ll give you a little inside secret; when a doctor sits down and makes eye contact with a patient, he/she ‘perceives’ the visit to be longer, more thorough and feels the doctor has good bedside manner regardless of what is said or what the outcome is. Back when I taught Family Medicine residents, I called this “Bedside 101”. It is a habit all doctors should be required to do and would have a greater impact on outcomes than the most advanced EMR (electronic medical record) software out there. My advice is echoed in research at Johns Hopkins which found doctors in training repeatedly failed to introduce themselves, sit down with patients, or explain what their role is in the patient’s health care treatment. This research was aimed at improved awareness of how doctor-patient interactions can improve patient confidence and compliance with treatment.
In another study of 800 recently hospitalized patients and 510 physicians found broad agreement that compassionate care is “very important” to successful medical treatment. However, only 53 percent of patients and 58 percent of physicians said that the health care system generally provides compassionate care.
Doctors that don’t even introduce themselves and talk down to patients may have bad manners but there is increasing evidence that this is no good for your health. Bedside manner seems to have taken a back seat to medication and high tech new tests that can be ordered. Times are changing for doctors with patient satisfaction surveys potentially affecting a doctor’s income. Thus, improved bedside may indeed equate to improved bottom line.
The Empathetic Doctor
The International Journal of Caring Sciences describes empathy as “the ‘capacity’ to share and understand another’s ‘state of mind’ or emotion” and a “powerful communication skill” that uses active listening and deepens understanding. This skill allows some doctors to fully grasp your apprehensions, concerns and the true weight of your questions when you’re in the examining room or hospital. Essentially, I think of it is being able to put yourself in another person’s shoes.
When you are in front of an empathetic doctor you are more likely to share intimate details you may not otherwise have been comfortable sharing with an aloof doctor. A vital part of what a doctor is trained to do is obtain a detailed medical history. If you are uncomfortable doing so because of the doctor’s demeanor, he/she is failing at obtaining information key to your wellbeing.
My Advice for Patients:
1. If your doctor has a bad bedside manner, consider changing doctors. However, sometimes this may be difficult depending on your insurance provider. If it is difficult to change, sometimes it is better to just approach the doctor with your concerns and let the chips fall where they may.
2. Ask for more time if you need it, so you can fully understand what the doctor has explained. Ask for a summary of what the plan will be moving forward.
3. Come armed with questions ahead of time. Many times when patients are in an environment with a doctor, they may be distracted or anxious. Have that list in your hand and make sure all of your questions get answered.
4. Remember that you are the patient and in reality, the consumer/customer. The doctor, nurse, technician, medical office or hospital exists and pays its bills because of you. Sometimes professionals forget this. Remind yourself this and if need be, remind them.
5. Be careful with the internet. A 2011 survey showed that 61% of patients said they researched health information on the internet to help with their medical care. 8% of doctors said that internet research by patients was helpful. There is nothing wrong, if you know your diagnosis, on looking into it further on the internet. However, searching ‘symptoms’ is ill advised and may bring un-necessary anxiety or confusion. If you are unsure of where to look for something, feel free to contact me.
I went into practice back in 1996 when we wrote in charts and I was able to sit and talk with patients. The internet was a non-factor. Times have changed, but what has not is the fact that you, as a patient, deserve a doctor who sits down, looks you in the eye, and listens.