The End of the Shift or the Next Patient

A recent study at the Johns Hopkins Hospital concluded that a surprising number of interns lacked what is referred to as ‘common courtesies’ when communicating with their patients.  The study leader, Leonard S. Feldman, M. D., an assistant professor of medicine at the Johns Hopkins School of Medicine, and his trained observers, followed 29 internal medicine interns for three weeks during January 2012.

Their findings were disturbing! Using five key strategies, that Dr. Feldman calls etiquette-based communication— the touch, asking open-ended questions, introducing one’s self, explaining one’s role and sitting down with the patient— the study reveals the following: The interns touched their patients, either as part of the physical exam, a handshake or as a caring gesture, only 65% of the time. During only 75% of the encounters, did they ask open-ended questions, such as “how are you feeling?” They introduced themselves only 40% of the time and explained their role at the hospital only 37% of the time. Finally, they sat down with the patient only on 9% of the visits. 1

Feldman’s co-author, Lauren Block, M.D., a former internal medicine fellow at Johns Hopkins, feels that one of the reasons for the interns’ lack of social protocol is that their teachers, the senior doctors that they learn from, often fail to use them. Block also points out that this breakdown in communication could also explain why some research has shown that “only 10% of patients can name a doctor who cared for them in the hospital.”

“My doctor is really good,” said a friend recently. Contrast this to another comment; “My doctor must be good.” The former statement is positive, while the latter conveys a lingering doubt. Both quotes connote a continuing ownership in the relationship. In the latter, the doctor has failed to make a connection and the patient is looking for reassurance. If the physician’s competence is also in question, patients often look elsewhere. The bridge to make that connection is what is called the ‘art of medicine.’ This art, which takes the relationship to a higher level, is often referred to as the physician’s bedside manner.2

Feldman also reports that research suggests that not only is patient satisfaction improved with the more frequent use of bedside courtesies, but that medical outcomes improve also.1 The literature chronicles numerous references to validate that improved mental health yields better physical outcomes. To even the most skeptical, it is impossible to deny that an emotional connection with someone who is treating them, but also cares about them, decreases pain and suffering.

The Johns Hopkins study clearly demonstrates that, what Feldman and his researchers label etiquette-based communication, appears to be of much less importance to many of the doctors that are entering practice today than the traditional responsibilities of physicians of past generations— the  key difference between being a good doctor versus a good physician.

The advances in the science are no excuse to abandon bedside courtesies!

The answer might be found in the time-honored concept of the doctor’s role of ministering to his/her patients. Translated, this means attending to the needs of the patient. To often, we tend to forget, that those needs are not just physical.

When patients refer to their doctors, but can’t recall their names or when doctors only remember their patients by their diagnoses are two examples of emotional abandonment by each party. Even more important, such physicians have failed to uphold the covenant our forefathers first made with their patients many years ago.

In a day when almost any advance can be construed as inappropriate, physicians must not be forced to abandon actions that insure commitment. A gentle touch, a reassuring smile and eye contact are sometimes the most effective therapy during difficult situations. At the very least, they are gestures of kindness and make a connection.2

Applying the science is only a part of the practice of medicine. In restaurant lingo, the concept is similar to eating great food, but being served by a terrible waiter. The food almost never makes up for bad service.

A simple observation seems to say it all: The doctor, who is primarily concerned with the science, looks forward to the end of the shift, while the true physician looks forward to helping the next patient.

Maybe, the most important legacy our generation of physicians can leave for the generations that follow are passing on the tenets that define this noble profession. But, how can these ‘new’ doctors know these time-honored principles, if we don’t follow them ourselves?

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References:

(2) Tenery, R., Morse, L., Bedside Manners: A Compendium of Physician Relationships, Createspace, 2014.

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