Sunday, October 02, 2011

Teaching bedside manner, $42 million

CBS in Chicago reports:

A Chicago couple thinks a doctor’s bedside manner is so important, they’re giving the University of Chicago $42 million dollars to teach it. Matthew and Carolyn Bucksbaum are backing the Bucksbaum Institute for Clinical Excellence at the University of Chicago. It will be led by Dr Mark Siegler – who’s been the couple’s physician. They say he’s the kind of doctor students should emulate. Carolyn Bucksbaum said the couple was motivated to make the donation after she once had a bad experience with an arrogant doctor who dismissed her illness.

The folks at the University explain more:

Medical students spend the first half of their education learning anatomy and physiology, and the second half applying that knowledge in the hospital. But where in that process do they learn the very important skill of listening and talking to their patients?

Teaching bedside manner may not be as straightforward as teaching biology, but creating a system of mentorship can help experienced physicians pass lessons down to young and aspiring doctors.

“The way you learn medicine is by seeing, not by talking. You have to show what good care is about. I learned from studying people like Joe [Kirsner],” [Mark] Siegler said. “Joe told us that everything was important, [including] science and clinical inquiry, but patients came first, patients were the absolute first priority.”

“One of the goals is the institute is to do the kind of translational research and outcomes research that we need to demonstrate the importance and effectiveness of good doctor-patient relationships,” Siegler said. “There’s a human encounter to deliver the scientific advance, and I think all of that is amenable to study.”

You can watch the video announcing the new center here.

Now, let's turn to a discussion on Medscape Connect (registration required), where the question is asked:

Is this something you can teach, or is it an innate quality? Is it possible to you teach compassion? Concern? Good manners? Or are these qualities already present (or absent) by the time you are old enough to apply for med school? And if it's something that can be acquired, how do you teach it? Even more important, how do you measure the results? 

Here are some excerpts from some comments, which seem to me to say as much about the "personalities" of different specialists as about the topic at hand:

Family Medicine doctor:  Agree that for the most part it is innate. However, with a great deal of effort some individuals can get better. I also believe that we're all human and some days are better than other days, thus we probably all have tendencies to be more outgoing and congenial some days than others.

How do you measure it? That's a great question. You would think patient surveys might capture it but I'm not convinced those are always completely accurate. I've seen some of these surveys where I know good and well that the person who treated the patient was exceedingly cordial,and explained everything in meticulous detail to the patient but they still got a bad rating.
Vascular surgeon:  I can see it now. One or two weeks "manners and bedside rehab." It will end up a charm school run by nurses. They would be better off  at 6 weeks Naval Officer Training School. At least you could get some of the barbarians in knife and fork training and how to wear appropriate clothing.
Family medicine doctor: I don't know if you can teach it, but you sure can bill for teaching it. My Institute would be willing to do the project for only 38 mil. Whom do I call?
Unidentified doctor:  A little boy pointing at the naked emperor.  I think the money should be used to train patients in "patient manner".
Cardiologist:  Typical academic pettyfoggery. Teaching bedside manners is nothing more  than teaching manners. Our society has promoted individualism to such  an extreme degree and has fostered the self-centerness which produces the nasty, hasty, arrogant doctors we all know. Doctors are merely reflecting  the mores of television. To spend money at this level to teach simple civility which should have begun in first grade is really stupid and wasteful.
Vascular surgeon:  Your MD and your license tells patients you are qualified. HOW you deliver that care is related to WHO you are. Thanks heavens we are all different. Most of us do a fine job of it. Some of us are ***holes. Just like in life. Live with it.

I can see a shape forming on the horizon. It is a government panel that will force future unlucky and hapless recipients of an MD degree to take a "sensitivity" course and become "certified" in Bedside Mannerism. Deviation from the strict behavioural checklist will result in job action and potential dismissal.

Glad I'm retiring. This is getting insane.
Pediatrician:  If medical schools want to teach "bedside manner" they don't need $42 million grants. The answer is pretty simple:
1. Stop accepting students right out of high school in so-called honors programs. Most of them (granted, not all) are simply too immature
2. Start recognizing that patients are clients, customers, and within professional bounds and obligations, deserve to be treated that way - and communicate that to students
3. Consider making experience in a setting where customer service is taught mandatory for either matriculating or graduating.
Emergency Medicine doctor: It's not about being"nice" or teaching manners. It's about giving patients understandable information in a non-judgmental way as part of a health care team. The more we understand the team concepts and are smart enough to learn communication methods to be effective and stay safe, the less we will have to think about manners school. If you build the expectations and learning models well, even disingenuous physicians can function. Case in point, surgical timeouts are often poo pooed by surgeons. If they own the process and operate in team mode, they could be a jerk and still accomplish the team's goal. How about involving patient and family on daily briefs regarding days expectations. This de-victimizes how patients feel and performs a function in bringing the patient and family into the care team. Structuring the communication takes away the fluff argument about manners school and other totally misunderstood models of behavior.
General surgeon: Plato asked via Socrates, "can virtue be taught?". The resounding answer was YES. If virtue can be taught then so can manners. A virtuous physician will have good bedside manners because he/she was taught well...or learned through years of practice what really works. Typical government grant. Let's throw money we don't have at a problem we don't understand. Wow. 42 mill is a lot of change.
Internal medicine: I am in primary care, so that colors my opinion, but my feedback from many patients who are dissatisfied with other physicians is that they did not feel that the physician listened to them, dismissed their input without explanation, or did not explain things. Although we all have innate talents, I think much of these behaviors could be improved.
Emergency medicine: Personality is largely hardwired, with high risk procedure medical or surgical specialties attracting self driven people less averse to risk (otherwise, how could they get so close to death each day without themselves choking). Solo types (eagles don't flock, nor do surgeons) may be less pleasant around others when sleep deprived or stressed. Most pediatricians are the opposite when sleep deprived (they don't get nasty).

In the future, when we eventually evolve into a two tier medical services system (as the rest of the world largely has and our own veterans now enjoy), the only primary care docs needing bedside manner will the "carriage trade" physicians, who will directly bill their patients. Those of us getting health care from the government provided services will be just happy to get our essential pills and life sustaining surgery, and not even be thinking of complaining how pleasant is the "provider".
Family medicine: Service orientation in a study by O'Connor was able to be taught, but it "stuck" mainly with those that had service orientation prior to medical school - females, married, older, and those "business like" (think waitress pursuing a tip). Madison and others indicate service orientation as indicative of primary care choice.

Newton in Arkansas noted empathy levels higher and more likely to be found in females and those pursuing core careers involving primary care, psychiatry, and women's health. These also tend to be lower income careers that are more focused on direct patient interactions, less focused on prestige, and less focused on board scores.
Urologist:  I have not read all postings. Those that I did read are interesting. Such discussions are good and useful, but please don't waste money to create another boondoggle. Bedside manners have been around since time immemorial. Some have them, others learn them but there always are a few exceptions. By the way, can anyone explain to me why any money is needed for this when there are opportunities to learn good behavior from family, schools, churches and temples, in medical schools and colleagues throughout life?
Hematology/Oncology:  I am thrilled to see this kind of study occurring. This will improve the quality of medicine. Bedside manners and empathy are teachable. This will also improve the health of health care professionals.


Christine and Petra said...

From Facebook:

Christine: If you know anything about the University of Chicago and its med school, which used to practice the pyramid system (accept lots of students, then wash them out through competition), they need the $42 million but don't necessarily deserve it. They are probably the peak of backwardness on patient activism.

Petra: The Schwartz Center for Compassionate Healthcare ( has been quietly doing this work for the past 16 years. You can read its "Agenda for Improving Compassionate Care" in the September issue of Health Affairs, the nation's leading health policy journal. Its signature program, Schwartz Center Rounds, was recently profiled in the New York Times by "Doctor and Patient" columnist Dr. Pauline Chen (

HealthMessaging said...

Thirty years of published research has consistently documented the poor quality of communications (aka bedside manner) between doctors and patients. That same research has shown that high quality doctor-patient communications is directly linked to superior patient outcomes, adherence, engagement, fewer tests and a better patient experience.

I recently wrote a paper in which I detail the scope of the problems with physician-patient communications as well as ways to begin addressing it.

I'd be happy to share a copy of the paper "Improving the Patient Experience in the Primary Care Physician's Office."

Steve Wilkins, MPH

Paul Levy said...

Thanks, Steve.

Dr.Theresa Willett said...

Reading some of the physician comments quoted from Medscape was so saddening! Many of us or our loved ones are patients, so I am amazed at the lack of appreciation for bedside manner. Communication is part of the therapeutic relationship. My mother, who has been struggling with breast cancer for > 1 year so far, has had terrible experience with most of her providers. What it comes down to is indeed communication and listening, 2 things for which insurance does not want to pay, so our medical establishment does not encourage enough. I have been shocked at how isolated, afraid, and disregarded she has felt due to poor physician relationships, and I have seen many more similar cases, at least with cancer patients. I am not sure grants and research alone will be enough, but certainly focusing on communication skills and desire to actually provide a service in training programs will be helpful!