Health Care

Beyond Technology: Bedside manners matter

A 2014 research review, indicates that a physician with good bedside manners can positively impact patient outcomes. The review, which was reported online in the journal, PloS One, covered 13 clinical trials, and revealed that when doctors were given training to enhance their interpersonal skills, their patients experienced better results when they attempted to slim down, to reduce their blood pressure or to manage painful conditions. It stands to reason that doctors with good bedside manners would also be less prone to making medical errors, since they are likely to be more empathetic and are more likely to sincerely care about their patients’ well being.  Empathy is the willingness and ability to understand other people’s feelings, and is a characteristic of helpful, pro-social behavior.

While we generally want this portion of our site to focus on healthcare technology, it has been increasingly observed that life saving technologies are of little use in the wrong hands, as medical technology, and radiology in particular, is being abused with impunity, as Consumer Reports, Huffington Post and other reputable publications have reported. This isn’t only a very expensive, psychologically taxing and physically dangerous case of bad business ethics that warrants attention, it is an atrocity, a form of human rights abuse that warrants collective outrage and action.

A review authored by Patient Safety America and published in The Journal of Patient Safety revealed that 210,000-400,000 Americans die every year at the hands of careless medical personnel. While there is a gross lack of sufficient data on the number of such deaths occurring in India, TOI reported in 2011 that the World Health Organization lists medical negligence/incompetence as one of the top ten killers globally, and that WHO is also convinced that one in 10 hospital admissions results in patient harm while one in 300 admissions leads to preventable death.

 

To some degree, we can probably wag fingers at shoddily run colleges or lackluster medical training, but what about the doctors who, as well heeled medical students, enjoyed access to some of the best medical training in the developed world? Other than pure, unadulterated arrogance, avarice and the inability to empathize with the very people they’re supposed to care for, what could possibly be their excuse?

Over the past 3 years, a few U.S. and Canadian universities seem to have awakened from a centuries long slumber and are finally taking some small (token?) steps to address this epidemic of rogue behavior within the medical community. In 2011, at Virginia Tech Carilion, administrators had an epiphany of sorts and realized that grades and test scores alone do not determine medical competence. The school then invited candidates to participate in nine short interviews that forced them to demonstrate whether or not they possessed the interpersonal skills required to work in the healthcare system. Some other universities that have adopted the MMI method include Stanford, UCLA and University of Cincinnati. This multiple mini interview (MMI) process of evaluating candidates has the potential to positively impact the entire healthcare system- assuming that students don’t soon figure out a way to outsmart interviewers.  Since those with certain types of personality disorders are skilled at learning to mimic acceptable social norms, perhaps a full psychological evaluation is in order so that those harboring such tendencies can be weeded out and prohibited from practicing medicine.  A study published in the American Journal of Psychiatry in 2002 indicates that physician empathy can certainly be measured.

In certain medical scenarios, a physician’s emotional intelligence, or lack thereof, can have a major impact on a patient’s chances of survival. Awake craniotomy, for example, is a type of neurosurgery that requires the patient to be awake while surgeons remove part of the skull in order to gain access to brain tumors or to perform other neurological procedures. Writing on the topic, Dr. Gabriel Rodriguez Portuguez said, “Acute stress episode, claustrophobia or intra-operative anxiety can end up in an emergency; consequently previous psychological preparation on patients is very important…There are more variables in the OR that generate anxiety in the patient such as low temperatures, odors, and other surgeries taking place in other ORs nearby which the patient might be able to see. As a result it is vital to be with the patient at all times talking ,encouraging and assuring him that he will be accompanied at all times and to remind him that his absolute cooperation would be needed.”

Consider this: Is a doctor who is unwilling to spend twenty minutes communicating effectively with you in the clinic actually fit to be prescribing pharmaceuticals, exposing you to radiation via medical imaging or cutting you open with a scalpel? How safe would you feel with a surgeon who can barely maintain eye contact with you? How safe would you feel with a surgeon who has a cold, hostile demeanor? What about a doctor who accuses you of lying when you disclose your dietary habits? Or one who refuses to change your medicine when you experience seriously harmful side effects? What about a condescending orthopedic surgeon who prescribes antidepressants for “stress” without bothering to view the herniated disc images that are clearly visible on the MRI films you’ve placed before him?  Most people would not socialize or go on dates with a person exhibiting such rotten behavioral traits, so why do they blindly trust such individuals to prescribe drugs, order tests and perform surgery?

Bedside manner” is simply a term to describe a physician’s interpersonal skills, or how he or she interacts with his or her patients, and clearly indicates how emotionally intelligent (or stunted) the doctor is. If your healthcare provider actively listens, addresses your concerns, communicates clearly, refrains from indulging in arrogant, condescending behavior, and speaks to you as if you have a functional brain in your head, then count your lucky stars and be thankful that your doctor is emotionally intelligent, and therefore cares whether you live or die. A physician possessing high emotional intelligence would be more likely to behave in a kind, sociable and attentive manner and demonstrate a positive, supportive attitude towards patients, colleagues and subordinate staff, and would be far less likely to put a patient’s health and financial stability at risk for a quick buck.

Regarding the subject at hand, renowned gynaecologist, Dr. Yvonne S. Thornton, MD, MPH, mentioned this in her blog:

Arrogance isn’t an occupational hazard, but over a long career in medicine, I’ve met too many physicians with this counter-productive attribute. I’ve always taken the time to listen to my patients, even if it meant that I didn’t get home by dinner or, when the kids were little, by their bedtime. But, to my mind, that’s a big part of what it means to be a good doctor.”

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Tracy Venkatesh

Tracy Venkatesh

Tracy Venkatesh has spent twenty years working and interacting with a socioeconomically diverse population in both the private and public sectors, and has held positions in multiple verticals including content development, healthcare, customer relations management, defense and law enforcement.

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