Mind Your Manners

Posted on January 1, 2014

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George Morrow / Punch Magazine 1914

George Morrow / Punch Magazine 1914

As the only year in which I have been both a medical student and a doctor drew to a close, I reflected on my new career.  In little more than 6 months, my level of responsibility will expand again, and I will be approving the decisions of the incoming flock of freshly-minted physicians (the only difference since the acquisition of their title being a lengthier white coat).

Panicked, I tried to think of things I had done really well this year.  Indeed, some of my triumphs were rooted in my growing prowess as a clinician, but without a doubt my most rewarding experiences had nothing at all to do with it.

It was the time my patient came back to the hospital to deliver a box of homemade cookies.  It was the hand-written thank you cards from patients and their families.  It was those patients who were genuinely happy to see me walk into their room at an ungodly hour after just having another few vials of blood harvested at my command.  It was working at an outside hospital and having patients ask for “my card” so they could see me in clinic, unaware that not only do I not have a practice, but that I am still supervised.

I contemplated what made these patients think of me as a good doctor.  They probably weren’t impressed by my ability to diagnose and treat their illnesses.  Their cases weren’t particularly interesting (pancreatitis, diverticulitis, diabetes, heart failure, pneumonia, cancer), and the outcomes weren’t always favorable.  Invariably, they thanked me for what boils down to bedside manner.

These are the patients I sat down with to go over a test, explain a diagnosis, discuss options, counsel, and console.  If they were inpatients, maybe I visited them more than once a day, after hours, or on my day off.  Perhaps I called them at home to ask how things were going after our office visit.  Patients want to have a connection with someone on their medical team – someone who understands their challenges, someone who will let them vent, someone who will help them understand.

Some claim bedside manner can’t be taught, or that it is cultivated only with many years of experience.  I don’t believe that’s true, and American medical schools certainly believe they can teach it.  While eye contact, professional dress, and courtesy can all be promoted by medical institutions, I don’t believe effective bedside manner can be learned in a classroom or taught by a mentor.  Surely, canned empathy leaves a more sour taste in the mouths of our patients than does stoicism (“I’m sorry for your loss – how many packs of cigarettes do you smoke?”).

Your patients will be the ones who teach you effective bedside manner, if you let them.  They are very good at letting you know what they don’t like, and through reflection on what you did differently for them to earn their praise will help you understand the impact effective bedside manner can have.

The problem is, it’s a significant time investment.  If the return on this investment is assumed constant, then the remaining variables are principal and maturity – and we have control over only one of those.  So why is it that I find more cards in my mailbox than other doctors at my level of training?  I simply invested more principal.

We often miss out on the opportunity to invest due to time constraints and our hurried interactions with patients or their families.  Who can blame us?  There are rounds to conduct, insurance forms to fill out, another admission arriving, professional certifications to maintain, and have you completed your HIPAA refresher course yet?

At a time when we are increasingly aware of physician burnout, when terms like “compassion fatigue” are being standardized, and with growing research linking communication skills to malpractice rates, the return on this investment is not only rewarding, but likely protective.

I implore my current and soon-to-be colleagues to invest early & often.

“Live a simple and temperate life, that you may give all your powers to your profession.  Medicine is a jealous mistress; she will be satisfied with no less.”

– Sir William Osler (1904)

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Posted in: Medicine