Doctors urged to mind bedside manners

If you want an idea of how much patients value a pleasant personality in their physician, consider that the Medical College of Ohio's largest individual gift ever, $1.9 million, came with the demand it be used to teach bedside manner.

The Ruth Hillebrand Clinical Skills Center, dedicated by the Toledo school this month, was borne of the estate of a New York psychologist who felt she had bad experiences with rude doctors. As the school told it, Hillebrand's doctor in New York called her late one night and told her she had mesothelioma. He said there was no treatment and no cure. Then he hung up.

Ruth Hillebrand, a Toledo native, died at age 67 in 1994, before she could fulfill her wish to find a way to use her wealth to train physicians in bedside manners. Her brother, handling her estate, had heard that the Medical College of Ohio taught these skills, and contacted the school about contributing money to its program. When he died, also of mesothelioma, in July 2004, Ruth Hillebrand's $1.9 million went to the college's clinical skills program.

The Ohio medical college is hardly the only school teaching physicians how to interact personally with patients. And there are programs in place for practicing physicians to brush up on their personal skills as well. This isn't because patients are saying, en masse, that their doctors are rude. Rather, they say they value physicians who have good bedside manners, which encompasses listening to and answering their questions and showing empathy and compassion when providing care.

"It's important to know what's right to do [medically], but it's also important to convey compassion and empathy," said Arthur R. Derse, MD, associate director of the Center for the Study of Bioethics at the Medical College of Wisconsin.

Increasingly, it's also becoming in physicians' best interests to make sure their patients are happy with their bedside manners. Rising deductibles and the drive toward consumer-driven health plans are making patients more financially responsible, and powerful, in their health care. Private pay-for-performance and bonus plans often include patient satisfaction surveys as a category in measuring physician effectiveness.

A 2004 Harris Interactive poll of 2,267 U.S. adults found that respondents cared more that doctors listened to their concerns and questions than they did about doctors being up-to-date on the latest medical research and treatment. A review of 25 surveys on doctor-patient relationships in the March 10, 2001, The Lancet said doctors with good bedside manners had a better impact on patients than physicians who were less personal.

"We shouldn't fool ourselves that it's just our technical skills" that patients value, said Timothy Flynn, MD, professor of surgery at the University of Florida College of Medicine.

A growing distance

"The average doctor today is just as compassionate, caring and empathetic as a doctor 50 years ago," said AMA President-elect J. Edward Hill, MD. His view is shared by many in the medical profession, who say the focus on bedside manner is not so much about physicians losing their humanity, but more about outside influences that have put wedges between patients and physicians.

Managed care means shorter times with patients and a lack of continuity as patients are less likely to stay with the same plan, and same physician, their entire lives. Doctors concerned about rising costs of medical liability insurance have said they've practiced defensive medicine to avoid lawsuits.

"That translated over time to the public [seeing the profession] as uncaring and unprofessional," said Philip Slocum, DO, vice president for medical affairs and dean of Kirksville College of Osteopathic Medicine in Kirksville, Mo.

Medical schools, in response, have developed curricula to help physicians with their bedside manners. At the Medical College of Wisconsin, students are offered the course "The Art of Medicine Through the Humanities," using journal writing and songs by famous chronically afflicted composers as entryways to learning empathy. The University of Maryland School of Medicine launched the Professionalism Project, which looks for compassionate students during admissions, and includes a humanism honor society with members who exhibit exemplary humanistic and professional behavior.

Not just for students

Practicing physicians also are getting help in brushing up their bedside behavior. Danville, Pa.-based Geisinger Health System has physician workshops that teach communications and empathy. Geisinger uses patient satisfaction surveys to measure physician performance.

"There is a sincere belief that good communication translates to better patient outcomes," said Bob Spahr, MD, Geisinger's senior vice president for service quality.

Researchers from the University of Washington Business School and Group Health Cooperative, in the March 2 Journal of the American Medical Association, suggested how physicians could tap into their emotions. For example, they said doctors can use "deep acting," a method-acting technique most associated with Marlon Brando, to conjure up past memories and feelings, then apply those to a present situation.

"If you've been practicing for 20 years and seen patients with cancer, you have that memory and that stored up experience and feeling to draw on," said Eric B. Larson, MD, MPH, article co-author and director of Group Health Cooperative's Center for Health Studies in Seattle. Dr. Larson also is chair of the board of regents for the American College of Physicians.

At the Medical College of Ohio's Hillebrand center, the school is planning to expand teaching of empathetic, compassionate care to nurses and other health care professionals at the school. Hillebrand's donation will also allow the faculty to observe, via television monitors, as medical students interact with standardized patients.

"Bedside manners do matter. Healing is relationship-driven," said Judy Riggle, director of the center. "If you don't like someone, you're probably not going to listen to them and do what they want you to do."