Why Bedside Manners (still) Matter

In the Information Age where access to “Dr. Google” is as ubiquitous as the latest online remedy for reversing the aging process, I am often amazed by the lack of attention my clinical colleagues pay to the importance of social media. Could this be a self-selected group of Luddites that possess some combination of fear and loathing as related to personal technology? Perhaps this is, actually, a more basic phenomenon: We, as clinicians have lost our way interacting with our patients. It is a harsh statement and one I do not make lightly.

As clinicians, we are taught, from day one, to listen to our patients. But are we listening? The distractions clinicians face today are many: over-packed clinic schedules; compliance with an ocean of regulations; electronic medical records that often lack intuitive clinical design; working in a multicultural environment with unique norms and expectations. All this before 9:00am in the morning. Inherently, our patient-centered focus is chipped away by the exponentially increasing number of demands placed upon clinicians.

Do patients notice when we’re not listening?

Without question, they DO notice. Patients (and their families) understandably focus on their own clinical needs. They have no inherent concerns about the 20 patients who came before them or the 20 patients to come after them. Moreover, they could care less as to whether we, as clinicians, need 6 keystrokes to enter a piece of data, or 22 keystrokes to accomplish the same task. Regulations, policies, and procedures are the artificial construct of a world they need not know. What our patients know is whether we are actively listening to their concerns and questions; whether we display empathy; and whether we display appropriate cultural sensitivity. We may not know the answer to every question proffered but most patients are more concerned with whether we actually care about their questions. Moreover, whether we acknowledge this fact or not, we, as clinicians, are brand ambassadors. Physicians serve as the single most important contact point within a healthcare organization. The fundamental decision as to whether a patient will return to a healthcare facility rests largely with interaction they have with our clinicians. And think about it: The ability to make a positive, empathetic impression, in the outpatient setting, may last less than 7 minutes. No pressure.

Connecting with our patients and making positive, empathetic connections isn’t rocket science nor as complex as neurosurgery.

But it does require time and self-discipline. As clinicians we need to take the time necessary to ask open-ended questions; listen to the answers, and provide thoughtful and salient follow-up questions. As for time: Perhaps no more than an additional 90 seconds to simply listen and respond. As for active listening: Avoid notation or data entry while interacting with a patient; provide eye contact with patients and families. And let us not forget to smile. All too often we take for granted that patients come to clinicians as if provided by some magic carpet or invisible conveyor belt. But it would be wise for clinicians to always remember that patients have a choice. Aside from life and death emergencies, patients and families can select from many clinicians from which to address their needs, concerns, and fears.

And as consumers they can easily vote with their feet onto the next hospital or medical clinic.

Instantaneous reviews have become as ubiquitous as smart phones. Restaurants, hotels, concerts, plumbers, and now, yes, clinicians. Where medicine has often become a commodity, what distinguishes one clinician from another may be as simple as a “thank you.” Most of us entered healthcare to care for others. Showing that we truly care, may be the very first lesson in medicine worth remembering.