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Whatever happened to “bedside manners”?

Doctor with patient in hospital

Stewart Hamilton, Chief Medical Officer at Medical Travel Commission looks at the soft side of delivering services to the medical traveller. What really makes a difference in terms of patient satisfaction? The surgery...the aftercare...or bedside manners?

Whatever happened to the old bedside manners of Marcus Welby MD and the gentleman professors of medicine of old - such as Professor Oglesby Paul at Northwestern University, Chicago and Professor Stuart Douglas In Aberdeen, Scotland? Unfortunately, it seems they are disappearing! No doubt it is in part due to the tremendous growth in technology! The MRIs, CT scans and Ultrasounds that allow us to see inside the depths of someone without laying hands on them also do rob us, as both patients and physicians, of the opportunity to interact as humans in the most basic way: with a non-sexual or sensual touch that as a physician I take to be both an honour and privilege to convey. On the other hand, if you happen to be lying there as a patient you quickly realize how helpless, hapless  and frail one really is and how strange it can feel to have your skin and organs poked and your basic bodily functions critiqued and analyzed by others. Maybe the non touch, impersonal and non judgemental characteristics of those assorted scans may be taken as an advantage by some, but there is much to be said for an empathic and reassuring human being. One who can give an explanation and perhaps some rationality to the cacophony of aches, pains, lumps and bumps that tend to appear with age or infirmity.


What makes a great bedside manner?

However, a great bedside manner is, for the most part, something that you are born with. Yes, we try and teach it but that which comes naturally is clearly evident as such. I am sure that we could argue as to what exactly constitutes a great bedside manner, but I would like to offer some physician attributes that should be emulated. Be on time; greet the patient by name; read the chart before entering the room; sit by the patient in a chair or on the bed, even one minute will seem like ten to the patient; touch the patient - a hand on theirs, a reassuring pat on the shoulder - each can convey a message of caring; introduce the members of your team; see and examine the patient daily - you would be amazed how many rounds are conducted from the end of the bed!; value the patients opinion by listening! As physicians we have a terrible habit of asking pointed questions and then interrupting the poor patient within ten to twenty seconds. A number of studies have shown that if we ask open ended questions and then continue to listen to the answer for ninety seconds or so, essentially all our queries and concerns would be covered! One should be prepared to be transparent particularly relating to outcomes and limitations. I do not consider it shameful to state that you do not know! In fact, I tend to look up to those who can admit to knowing that they do not know! Colleagues that are of most concern are those that don't know that they don't know, and tend, of course, to consider themselves all knowing. They can be truly dangerous! To the outsider, they can be hard to distinguish! Other physicians tend to be the best method of discrimination and though they may be reticent to "finger" a colleague, they likely would tell you whether they would be willing to see that person as a patient themselves!


Try it for yourself

For years, I have suggested to all who might listen, that all medical students and/or interns should be made to spend at least one weekend in bed in hospital as at least a pseudo patient. No getting out of bed. No bathroom privileges and no getting up to eat. This experience will change many attitudes and will benefit so many people down the years who will find themselves being cared for by physicians and nurses, often many years their junior. There is no more vulnerable a position to be in than to be lying helpless, in that basic bed, in a functional room. Totally dependent on the ministrations of others whose attitudes and reactions can make or break your day, or at least your most current half hour or so. Lying there teaches humility, grace under fire and the patience of Job! On the other hand, walking in as the big wheel doctor or nurse, faced with a helpless patient, totally dependent on your whim and mood of the day, can engender a misplaced sense of control and power! One that is totally undeserved and can be rapidly reversed by one's own slip, fall, car accident or freak of nature. I have both been the victim and power broker. My first time this occurred was during a six month spell in Chicago at Northwestern University Medical School on an exchange from the University of Aberdeen, Scotland. One day I was the junior intern/doctor on call, the next I was a patient with severe mononucleosis and a very large spleen. Boy, did those nurses and doctors teach me a lot! I saw all extremes of attitude and attention. Mostly pretty good, but there were a couple of folks that I swore I would do my very best to remember and to try and emulate! Sam Macaluso MD was a young attending who was kind, considerate and really thoughtful. I remember his name to this day for his kindness and great bedside manner! He was also so good as to return to me the monies that my father's insurance had provided for doctor bills. That was another wonderful example of the gentleman that he was and that message clearly resonated with a young Scotsman!  


What makes a satisfied patient or medical tourist?

So... what is it that makes a satisfied patient or medical tourist? In the healthcare business, we are all seeking and trying to reproduce the satisfied customer/patient! As patients we expect, really assume, that the technical aspects of our care will go well. But particularly as individuals that may have traveled for care and are often paying for care ourselves, we have other expectations. They are very likely to be "softer" in nature; such as transportation back and forth to the hospital, hotel and airport; suitable and safe accommodation for family or friends; a summary of the tests, procedures and blood work that I can take back home with me; means with which to communicate with at least my caregivers while I am away from home (such as a loaner phone/computer); provision of medication for the trip back home and advice as to the safest and most comfortable way and time to travel home. By the way, before I even sign up for my procedure or work up away from home, I also want to see and speak to the physicians that will be taking care of me. I really need to feel a transparency of information. They should be able to tell me how many of my type of procedure they have done. What was their success rate? What sort of recovery period should I expect? Will I be able to eat, play golf, walk, cycle as I used to do and when? If you cannot, or will not, provide that basic information or do not have the time to talk with me, I doubt that I will find the time to visit your fair city, country or region!


It’s about meeting patient expectations

Satisfaction is all about meeting expectation. If you meet my expectations, then I am a satisfied customer. If not, I will be quite likely to broadcast that dissatisfaction to all who might listen. Wearing another hat, however, if you do not know what my expectations are, how can you meet them? Is that my problem, as the patient, or is it yours as the program administrator or physician. Probably both! Each needs to ask our questions. The best medical travel program will ask a myriad of questions and likely some previous medical history and results of  investigations will be required. No doubt the more sophisticated travelers (who are of course, the readers of this piece!) will be sure to define their expectations so that they are more likely to be met. If we can find the middle ground between Charles Dickens - who had "Great Expectations" and the Rolling Stones that "got no satisfaction"! We will all be the happier! Happy medical travels!!

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Profile of the author

Stewart Hamilton, Medical Travel Commission

Dr. Stewart Hamilton, Chief Medical Officer of The Medical Travel Commission, has over two decades of experience in medical staff leadership roles. His medical practice has taken him to countries such as the United Kingdom and South Africa. His board certifications and fellowships are recognized in the US, UK, Australia, New Zealand, Hong Kong, India and Pakistan. He worked as a consultant to the Centers for Disease Control and led a World Health Organization affiliated Education Center. He has most recently been appointed to the National Certifying Commission of the National Association of Medical Staff Services.

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