Saturday, October 1, 2011

Bedside Manners Worth $42 Million

A Chicago couple believes doctors should have good bedside manners and they have ponied up $42 million dollars to teach it.  Matthew and Carolyn Bucksbaum have donated to the Bucksbaum Institute for Clinical Excellence at the University of Chicago.  They made the donation for their own personal physician to lead it and say he's the kind of doctor students should emulate.  They were motivated to make the donation after Carolyn had a bad experience with an arrogant doctor who dismissed her illness and never apologized.

Large medical groups measure "patient satisfaction" with the physician and the medical office.  Doctors who are very good clinically can have horrible scores because of bad bedside manner.  There are many consultants who will come into an organization and "teach" better rapport.  And it is a well known fact that doctors with good communication and interpersonal skills get sued less...many times less or not at all!

Are empathy and interpersonal skills innate or can they be trained?  Does medical school select for self-absorbed students or do they become jaded and arrogant from years of training and working with demanding patients?   We know the science of medicine can be learned.  Can the art of medicine be taught too?  Is it OK to have an excellent surgeon who saves your life but has the personality of a warthog?

I think there are basic manners and ways of communicating that can be taught. (hopefully by parents at age 3 but later by consultants if that didn't happen).  A small percent of doctors, like in the general population, have a personality deficit or a narcissistic personality and will never learn empathy or good communication.

The remainder of good "bedside manners" starts with  giving patients information in a respectful way that they can understand.  That takes time (trainable) and intuition about how to communicate with different people's personalities (innate).  Good bedside manners means not badmouthing other caregivers (trainable) and also instilling confidence and trust in your ability to help the patient problem (innate).
Eye to eye contact, tone of voice are trainable, but the ability to have true respect for the patient and understanding the full context of his disease is innate.

Time will tell if the $42 million pays off.  Teaching young doctors how to communicate, how to be team players with other clinicians and how to follow the golden rule (Treat others as you would like to be treated yourself) sounds simple but would certainly improve patient care going forward.

What do you think?  Will it be $42 million well spent?  Can bedside manners be taught?


Anonymous said...

I am currently studying medicine at the University of the Philippines and we have this subject called "The Art of Medicine". We take it once a week, along with our Pathology, Pharmacology subjects. We have lectures on patient care, bedside manners, and such. I don't know how this subject can affect us, but it's the College's way to change the image of our graduates. Our graduates used to be known as the brilliant doctors who are arrogant as hell, but can treat you with great skill.

Toni Brayer, MD said...

Chakaichax: Thanks for your International comment. Fascinating. I believe there is no true healing until the doctor shows he/she really cares.

KM said...

A friend asked if I would go with her to one of her parent's first oncologist appointment to help ask questions and remember what was being said. I know being an oncologist must be the toughest job and a high burn out rate, but I was appalled that an older experienced oncologist at a well thought of hospital would tell a patient and their adult children that the diagnosis was stage IV malignant cancer and give a diagnosis of 3 months without treatment and only if chemo. worked maybe 6 months, without any apology for the horrible news. I wondered how would this doctor like to be told she had 3 months left to live and not hear any compassion or empathy with an apology or to herself or her family.


Tracy said...

In South Africa the nurses are extremely arrogant. I help out at a hospital and they tell the doctors to prepare their own surgeries. As unbelieveable as this sounds patients are lost on their way to surgery and doctors are left running around looking for them. Patients are given the wrong medicine often or the doses are incorrect. Unfortunately disciplinary action has never taken place and over the years their arrogance has led to patient maltreatment and in a number of cases death. People pay a fortune to have medical aid here because we fear for our life should we end up in a public hospital. It is not uncommon to stand waiting in an emergency room while the nurses are eating on break. You can die waiting but they will finish their break before they attend to you.

Anonymous said...

I am a 4th year medical student. I often listen to my mother talk about her doctors, which she finishes with what she likes and dislikes about them. She tells me "do this" and "don't do that" and "don't say things like that." And often I reply with "I know mom, I know." I think this harkens back to what you were saying about learning manners at age 3. Patients often tell me they like my bedside manner.

I have heard nightmare stories about my classmates' mistakes. Word travels fast. This always makes me think that "it should be common sense" but apparently not. I just wonder if $42 million spent in one city will make a big enough dent in the shortcomings of the human beings held to a higher standard.

I think the easiest and cheapest thing we could do is just to figure out at age 3 that we want to be doctors.

A Los Angeles Cardiologist said...

Thank for that interesting post. I think that vast majority of doctors really do care about their patients and want to have good bedside manners. Interpersonal skills are a lifelong learning process. But most patient encounters are fairly structured and within that context I think that skills to improve the patient's perception of empathy and respect by the doctor are teachable.

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