“Bedside manner” is a familiar term that remains difficult to define. Although it’s possible to intuitively differentiate between physicians who demonstrate “good bedside manner” and those who don’t, it is often hard to verbalize this delineation.
Having a “good bedside manner” is something that we as orthopaedic surgeons should strive for, but public perception of our profession indicates that many of us don’t always display it. Medicine is transitioning away from an era where physicians had the time to develop strong interpersonal bonds with their patients to a more sterile, business-like model where patients are “customers” or “clients” and physicians are “providers.”
Brief encounters between physicians and patients aren’t satisfying for either party. Electronic medical records further dehumanize the physician-patient interaction by forcing doctors to spend time entering information into the computer instead of engaging in face-to-face communication with their patients. In addition, patients now have the unprecedented ability to influence a physician’s reputation simply by rating their doctor visits (often anonymously) on various websites.
As orthopaedic surgeons, we may know the science of medicine but few of us have any training in the art of medicine. It is critically important that surgeons learn how to positively affect their patients during each encounter, no matter how brief. The following suggestions can be learned and applied by anyone to help strengthen and improve relationships with patients.
Know your patient
Before you enter the patient’s room, check the person’s name and demographic information. Using the patient’s name is important and empowering. If you aren’t sure how to pronounce the name, ask. Taking the effort to learn the correct pronunciation will be appreciated.
If you’ll be seeing the patient over time, learn about his or her family. A simple reference to a personal detail will go a long way to strengthening the patient-physician bond.
Neither you nor any member of your staff should refer to patients by their body part or condition. In most offices, patients can hear what is being said outside the room and they notice if you are thinking about them as a whole person or just a part.
If you have a multicultural patient population, familiarize yourself with some unique aspects of each culture. The AAOS has a variety of culturally competent care resources available online at www.aaos.org/diversity
Upon entering the room, introduce yourself to the patient and family members. Do not automatically assume that the patient knows who you are. Many offices have residents, nurses, and physician assistants who may see the patient before you do. With multiple people coming in and out of the exam room, the patient can become confused and think someone else is the doctor.
State your name clearly and offer to shake hands. This simple gesture lets patients and their family members know that you respect them and gets the interaction started in a friendly manner. Don’t underestimate the value of the human touch. The more opportunities you have to “touch” the patient, the more satisfied he or she will feel with the visit.
Sit down. Sitting is especially important if you are seeing a patient in a wheelchair. Many patients have subconscious feelings of subordination as they look to their physician for guidance with their problems. Sitting helps reduce this feeling, lets patients look at you at eye level, and indicates you are equals in the relationship. A rolling stool is an invaluable exam room aide.
Start your discussion by using an open-ended greeting such as “How may I help you?” This shows that you are there to serve the patient and gives patients the freedom to answer as they wish.
Listen to what the patient says and resist the urge to interrupt. Studies have shown that physicians stop patients and redirect the conversation after about 20 seconds, while patients need an average of 32 seconds to complete their explanation of concerns. Waiting a few more seconds to allow patients to finish their thoughts will be appreciated. In the words of Sir William Osler, “Listen to the patient. He is telling you his disease.”
Maintain eye contact and give the patient your undivided attention. Don’t fiddle with your cell phone, look at the computer screen, or type. Jot a few notes during the conversation and enter the information later.
Perform a thorough physical examination, even on a seemingly routine problem. Human touch is very important and creates an unspoken bond between the physician and the patient. Patients expect the physician to touch them as part of the process to evaluate their problem. Patients will notice if you do only a cursory exam and they will feel dissatisfied if you don’t take the time to properly assess them.
Avoid using too much medical jargon when explaining a diagnosis or a surgical procedure to patients. Begin by using layman’s terms wherever possible and then increase the complexity of the discussion if the patient seems capable of understanding it.
A discussion that starts with terms like “proximal,” “distal,” “osteotomy,” or “arthroplasty” will sound like a foreign language to most patients and only confuse them. Orthopaedic terms may be second nature to you, and you may not even notice that you are using them. Think carefully about what you are saying and find ways to explain the problem without having to use clinical terms, even if it takes more time.
For example, instead of saying “Your child has a Salter-Harris II fracture of the proximal tibia that requires open reduction and internal fixation,” say “Your child has a break in the top part of the shin bone that involves the growth center. It will require an operation so we can put the bone back together and hold it with metal screws.”
At the end of the visit, summarize the information in a few sentences and ensure that the patient leaves with a clear understanding of what to do. Studies have shown that we physicians often don’t do as good a job of explaining the diagnosis to the patient as we think we do. Answer all of the patient’s questions thoroughly before ending the visit. Wrap up the encounter by asking, “Do you have any more questions?”
Look the part
You have only one chance to make a first impression. Studies have shown that people base their opinion about you within 2 seconds of meeting, based on your appearance, body language, demeanor, mannerisms, and dress. In addition, patients have certain expectations about how physicians should look and act.
For these reasons, you should always present yourself in the most professional manner at all times. If you wear a white coat, make sure it is clean. Avoid eating, drinking, or chewing gum in front of the patient. Do not curse or yell in the office because patients will hear you.
Although cell phones serve a critical role, they can also be annoying and intrusive. Out of courtesy to your patients, practice cell phone etiquette by switching your phone to silent (vibrate) mode while interacting with patients. Most offices require patients to refrain from using cell phones in the exam rooms; you should follow the same guidelines. Taking a personal call in the middle of a patient discussion sends the message that the patient is not important.
Time is valuable to everyone. Do your best to be punctual. The best way to keep on time is to start on time. Patients may expect to wait a certain amount of time, but there are limits. If you are running behind, apologize to the patient. The excuse may not be important; it’s the acknowledgement that you value their time that counts. Offices that are efficient and run on schedule will be popular with patients.
The corollary to being punctual in the office is responding to messages in a timely fashion. A patient who is waiting for the results of a test or the answer to a question is often worried and eagerly anticipating your call. Do your best to answer each message as quickly as possible. Don’t let it linger in your to-do box. Your patients will appreciate hearing from you.
Don’t be afraid to tell the patient “I don’t know.” Sometimes the diagnosis isn’t clear and the patient will appreciate an honest assessment more than a guess. Letting patients know what they don’t have is often as important as determining the actual diagnosis. It is reassuring for a parent to hear, “I am not sure why your child is limping, but there doesn’t seem to be any sign of an infection or a fracture.”
When evaluating new patients as a second opinion, however, avoid the inclination to disparage the previous physician—no matter how much you disagree with the previous diagnosis and course of treatment. Speaking ill of another physician does not make a positive impression.
After a surgery or procedure, have someone on your staff contact the patient the following day to see how he or she is doing. Patients like to know that you are thinking about them even when they are not in the office or hospital. It also provides an opportunity to catch any problems or issues early.
Healthy relationships with patients are critically important in today’s medical climate. These suggestions can help you develop and maintain strong bonds with your patients. If you set a high standard for professionalism, your staff will follow your positive role model.
Although these concepts may seem simple, applying them consistently is difficult. Practicing a “good bedside manner” will keep your existing patients happy and attract new patients to your practice. If you consistently try to picture yourself in your patients’ position and treat them the way you would want to be treated, you will understand the meaning of “good bedside manner.”
Christopher A. Iobst, MD, practices in the Department of Orthopaedic Surgery at Miami Children’s Hospital. He can be reached at email@example.com
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