The medical school did not teach me the bedside manner. In my family medicine support program, they really emphasized the role of the doctor and the importance of communication. The fact is that the bedside style is really not taught. Some documents have it, and some just do not. In a recent clinical study it was demonstrated that:
“The patient’s attitude to the clinician had a“ statistically significant effect on treatment outcomes. "
While the United States spends more than 2 times more on healthcare than most developed countries in the world, it lags behind a number of countries in terms of the health and longevity of patients.
Could the decision be as simple as doctors when listening to patients? My opinion is: Yes.
Let me give you an example. What I call CYA & OT & # 39; doctor. (Close 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 had no changes in vision, trauma, migraine symptoms, or neurological symptoms. In fact, she really had a dull pain and tightness in the neck and forehead. She was stressed and she had her head stretched, which always matched either 800 mg of ibuprofen or Toradol’s shot (anti-inflammatory). She told the nurse about it. She told the doctor about it. She told them about her diagnosis and treatment.
Somewhere between 40-55% of patients going to the ER, the primary care department or the emergency room, "will tell you the diagnosis."
She never received any treatment for her tension headache. She received an MRI, blood tests, an ECG and the direction of neurology. Communication breakdown = inefficient and unreasonably expensive assistance. She missed work because she was not grateful. This is a complete system failure.
There is absolutely no place to share all such anecdotes. Bad bedside means poor communication with patients and worse results.
Perhaps doctors should just listen to patients. In an analysis of 13 studies conducted by the NORC Research Center, 59% of Americans, as has been shown, attach importance to the relationship between doctor and patient and personality, with only 11% evaluating the exact diagnosis and treatment. How much time a doctor spends with a patient is very or very important for 80% of people. One thing I learned at an early stage was to "sit down and meet with the patient." (I know enough, but isn't everyone doing it now?). This study showed that a positive doctor-patient relationship can have a statistically significant effect on “severe health outcomes,” including obesity, diabetes, hypertension, asthma, pulmonary infections, and osteoarthritis pain. The study looked at studies in which doctors were randomly assigned, either to provide them with normal treatment methods, or for additional training or steps to provide more emotional and patient-oriented care. The extra care made a measurable difference in medical results.
I will give you a little secret; when the doctor sits down and comes in contact with the patient, he / she perceives & # 39; the visit will be longer, more thorough and considers that the doctor has a good bed rest, regardless of what is said or what the result is. When I taught residents of family medicine, I called this “bed 101”. This is a habit that all physicians should do and will have a greater impact on the results than the most advanced EMR software (electronic medical record). My advice was repeated in the study of John Hopkins, as a result of which doctors in training did not repeatedly present themselves, sit down with patients or explain what their role is in treating patients. This study aimed to raise awareness of how doctor-patient interaction can improve patient confidence and adherence.
In another study of 800 newly hospitalized patients and 510 doctors, there was broad agreement that compassionate care was “very important” for successful treatment. However, only 53 percent of patients and 58 percent of doctors said that the health system as a whole provides compassionate care.
Doctors who do not even introduce themselves and do not talk to patients may have bad manners, but there is more evidence that this is not good for your health. Bedside style seems to be entrenched in drugs and high-tech new tests that can be ordered. Times change for doctors with patient satisfaction surveys that potentially affect a doctor's income. Thus, an improved bed can really equate to an improved bottom line.
Empathic doctor
The international journal “Science Care” describes empathy as “the ability to share and understand another state of mind or emotions” and “a strong communicative skill,” which uses active listening and deepening of understanding. This skill allows some doctors to fully understand your concerns, concerns and the true weight of your questions when you are in the examination room or in the hospital. In fact, I think that this is an opportunity to put myself in someone else's shoes.
When you are in front of an ambrate doctor, you have more chances to share intimate details, and you might not be able to safely share with a brave doctor. An important part of what the doctor has trained is to get a detailed medical history. If it is inconvenient for you to do this because of the behavior of the doctor, he / she cannot obtain the key of information for his well-being.
My advice for patients:
1. If your doctor has a bad bedside reception, think about changing the doctor. However, this can sometimes be difficult depending on your insurance provider. If this is difficult to change, it is sometimes better to simply go to the doctor with your problems and let the chips fall where they can.
2. Ask for more time if you need it so that you can fully understand what the doctor explained. Ask for a brief summary of how the plan will move forward.
3. Come armed questions ahead of time. Many times when patients are in an environment with a doctor, they may be distracted or preoccupied. Keep this list in your hands and make sure that all your questions are answered.
4. Remember that you are a patient and, in fact, a consumer / customer. A doctor, nurse, technician, medical office or hospital exists and pays its bills because of you. Sometimes professionals forget about it. Remind yourself this and, if necessary, remind them.
5. Be careful with the Internet. A study in 2011 found that 61% of patients said they were looking for medical information on the Internet to help with their medical care. 8% of doctors said that an online study by patients was helpful. There is nothing wrong if you know your diagnosis by studying it further on the Internet. However, searching for & # 39; Not recommended and may cause unnecessary anxiety or confusion. If you do not know where to look for something, do not hesitate to contact me.
I entered the practice back in 1996, when I wrote in the charts, and I could sit and talk with patients. The internet was not a factor. Times have changed, but not the fact that you, as a patient, deserve a doctor who sits down, looks into your eyes and listens.
Good luck,
Dean M. Tomasello, MD
