Developing bedside manner comes from understanding who the patient is

Over the years I have strived to develop my bedside manner.  On rounds many learners comment on this aspect of my doctoring, and these comments have led to much self reflection.  This commentary may convince some readers that I have the answers, but I do not.  Sometimes I do very well, but sometimes my skills fall short.  I do try to connect with patients and families, and give them confidence, hope and realistic expectations.

Being the product of a liberal arts education (psychology major at the University of Virginia) and being a life long reader, music lover, as well as going to movies and watching some selected TV shows, gives me a broader understanding of the human condition.  The first thing (and perhaps most important thing) in developing one’s bedside manner comes from understanding who the patient is.  Observers since Osler have quoted him often. Particularly like this quote: “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.”  When you understand patients, then you can talk with them on their terms.

We must work at understanding our patients and how to connect with those patients.  When physicians first walk into the room, the patients usually view us positively.  Our job is to earn that trust, and help the patient understand what we think and what we plan to do.

It helps to like most people.  It helps to empathize, imagine their situation and understand their expectations.  Some patients want detailed sophisticated explanations.  Some patients want to research and control the decision making.  Many patients are just scared and want someone to tell them what to do (channel this common comment: “You’re the doctor.”)  Some patients have great medical sophistication, while others have just fear and virtually no understanding.  In my corner of the world, patients seem to speak multiple varieties of English: urban poor, urban sophisticate, rural poor, rural sophisticate, immigrant English, no English, drug user English, etc.  We have to have a sense of all these languages.

Despite the differences in patient types, all patients want a physician who listens and explains.  All patients value a physician who sits down at the bedside.  Sitting makes the patient understand that we have time to talk.  Touching the patient develops a sense of connection.  Caring becomes evident in our faces, our words and our touch.

We must always remember how vulnerable patients feel.  Many patients have difficulty comprehending their disease.  They really only understand that they feel weak, or pain, or dyspneic or confused, or …  They want us to fix them.  We cannot always do that.

Bedside manner helps comfort the patient during times of discomfort.  We cannot learn bedside manner from a book.  We do not really understand how to measure bedside manner.  We know good bedside manner when we see it, but can we mentally dissect these interactions to learn how we can improve.

Take time to listen to the patient’s concerns.  Ask about their understanding of the disease, the current situation and the plan.  Correct their misconceptions.  Learn to explain complex disease in terms patients can understand.  Remember that health literacy is not just about the written word.  Patients cannot process fancy medical terminology, so we must alter our words to their vocabulary and their level of understanding.

For the students and residents who read this blog, practice your bedside manner every day, and then honestly assess yourself.  Learn your strengths and weaknesses.  Play to your strengths, and do your best to hide your weaknesses.

We owe our patients.  We work to serve them, and thus they deserve our full attention and the best possible communication skills.  When you are a patient, you are vulnerable, and we must do our best to comfort, explain and make clear that we care.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

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