Why Nice Doctors Are The Best Doctors

Medical School did not teach me bedside manner. In my Family Medicine residency program, they really stressed the role of the doctor and importance of communication. The fact of the matter is that bedside manner is really not universally taught. Some docs have it and some just plain don’t. In a recent clinical study it was demonstrated that:Let me give you an example. What I call the ‘CYA & OT’ doctor. (Cover 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 didn’t have vision changes, trauma, migraine-type or neurologic symptoms in fact she really just had a dull pain and tightness in the back of her neck and forehead. She was stressed and it was a tension headache that always responded to either 800mg of ibuprofen or a shot of Toradol (anti-inflammatory). She told the nurse this. She told the doctor this. She told them both her diagnosis and treatment.Somewhere between 40-55% of patients walking into an ER, primary care office or urgent care center will “tell you the diagnosis.”She never received any treatment for her tension headache. She received an MRI, blood tests, an EKG and a neurology referral. Communication breakdown = ineffective and unnecessarily costly care. She missed work because she wasn’t treated. This is a total system failure.There is absolutely no room to share every anecdote like this. Poor bedside manner means poor communication with patients and worse outcomes.jitendra swarup md

Americans were shown to place value on physician-patient relationships and personality with only 11% placing value on accurate diagnosis and treatment. How much time a doctor spends with a patient is very or extremely important to 80% of people. One thing I learned early on was to “sit down and face the patient.” (Pretty basic I know but docs don’t all do this now do they?). This study demonstrated a positive doctor-patient relationship can have statistically significant effects on “hard health outcomes,” including obesity, diabetes, hypertension, asthma, pulmonary infections and osteoarthritis pain. The research looked at studies where doctors were randomly assigned either to provide their normal methods of care or to take additional training or steps to provide more empathetic and patient-focused care. The additional care made a measurable difference in medical outcomes.

I’ll give you a little inside secret; when a doctor sits down and makes eye contact with a patient, he/she ‘perceives’ the visit to be longer, more thorough and feels the doctor has good bedside manner regardless of what is said or what the outcome is. Back when I taught Family Medicine residents, I called this “Bedside 101”. It is a habit all doctors should be required to do and would have a greater impact on outcomes than the most advanced EMR (electronic medical record) software out there. My advice is echoed in research at Johns Hopkins which found doctors in training repeatedly failed to introduce themselves, sit down with patients, or explain what their role is in the patient’s health care treatment. This research was aimed at improved awareness of how doctor-patient interactions can improve patient confidence and compliance with treatment.In another study of 800 recently hospitalized patients and 510 physicians found broad agreement that compassionate care is “very important” to successful medical treatment. However, only 53 percent of patients and 58 percent of physicians said that the health care system generally provides compassionate care.


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