Bedside Manner Matters

Lambeth Hochwald

June 24, 2024

While every patient hopes to be seen by a doctor with the perfect blend of diagnostic skills and empathy, good bedside manner isn't always a given, especially as doctors become increasingly time-crunched, mired in electronic health records, focused on care coordination, and pressured to get to the patient in the next room.

"I've noticed there are certain types of doctors who are very intelligent but don't have that communication connection with patients," said Errol Ozdalga, MD, assistant professor of medicine and director of the Stanford Medicine 25, a program at Stanford University School of Medicine, Stanford, California, led by Abraham Verghese, MD, that teaches and promotes bedside exam skills.

Verghese tells Medscape Medical News that some physicians are terrifically emotionally intelligent but not technically as good. "When I see a doctor with both qualities, I consider that person a double threat."

Because bedside manners may be subjective, defining what constitutes the best ones is unique to each physician — and this is something that usually comes through right away in online reviews. And it's the first thing patients complain about in negative reviews.

For Michael Cameron, MD, a dermatologist in private practice in New York City and assistant clinical professor in the Department of Dermatology at Mount Sinai Health System, having a good bedside manner means treating patients the same way he treats members of his family.

"Patients want to feel comfortable around their provider, so one way I do that is to try to get to know them as human beings, not just patients," said Cameron. "I try to convey confidence as well as approachability."

Good bedside manners are critical because empathetic listening enables physicians to establish a relationship of trust and confidence, said Nayan K. Kothari, MD, chief academic officer at Saint Peter's University Hospital in New Brunswick, New Jersey. "Not having appropriate bedside manners increases the probability of mistrust, ordering unnecessary tests and consults for the physician, which then adversely affects the well-being of the patient."

To that end, Saint Peter's has developed a robust curriculum called the Advanced Course in Communication and Physician Examination, a 2-hour-a-week course that takes place over 50 weeks.

"This covers two of the most important aspects of being a physician," Kothari said, adding that the course includes a didactic presentation, a practicum where a real patient with real physical exam findings is brought to the classroom for an interview. The course ends with a final exam created in collaboration with the Royal College of Physicians in London, England.

For Stanford's Ozdalga, helping medical students hone their communication skills has been personally fulfilling.

"I teach medical students that it's an art to talk to people, to be sensitive in terms of what you're hearing, and make sure you care about their agenda — not just your own."

Although communication is one of six core competencies in medical education, medical school students have historically been taught to focus more on the mechanics of taking a history and performing physical exams.

"While medical schools highlight the questions you're supposed to ask, the exams the person needs, and a checklist of questions, you learn so much more through observation and listening — which is what we focus on in our course," Ozdalga said.

Taking the time to connect with a patient can be difficult, given the challenges that exist in healthcare today, said Lisa Howley, PhD, senior director for transforming medical education at the Association of American Medical Colleges.

"Shortened patient encounters and staffing issues are certainly barriers in place that are systemic and that make it challenging to spend quality time or provide resources and support that would be ideal," Howley said. "The solution isn't an easy one."

At Saint Peter's, the mission is tactical, as the goal is to quell some of the issues that arise following poor communication with patients.

"One of the challenges facing physicians today is insufficient education in the practice of bedside manners," Kothari said, adding that this leads to cursory history taking, limited physical examination, and poor differential diagnosis decision-making. "This, in turn, has led to excessive and unnecessary testing, creates a lack of patient satisfaction, and increases the risk of litigation."

It's yet another reason Stephen Berns, MD, associate professor in the Division of Palliative Medicine at The University of Vermont Larner College of Medicine, Burlington, Vermont, is thrilled that, in the past 5 years, medical school admissions evaluations have become more focused on a candidate's emotional intelligence as well as their Medical College Admission Test scores.

"Medical schools are looking for someone's emotional capacity and empathy vs how many papers they've published," Berns said. "Since this has started happening, I've noticed a difference in the skillset our students bring to patient-centered care."

Responding to a patient's emotions directly can also make all the difference.

"I've seen anecdotally that if you don't respond when a patient has an emotional reaction, they won't hear what you're saying," Berns said. "Let's say I shared some serious news that a patient had a cancer come back, and the first thing they say is, 'can you rerun the test?' We're trained to respond to the question, but if, instead of saying you can't, you say, 'I see this is surprising news to hear', you're acknowledging their emotion and that can move the conversation in a way better direction."

Ultimately, good bedside manners simply come down to thinking about what it must be like to be on the other side of the exam table — every single time you enter the room and meet a new or existing patient.

"I've been on the other side and have had to advocate for loved ones, so I've been able to observe the good and the bad among doctors," Cameron said. "While you don't need to have been a patient to have empathy, it's something every healthcare provider should be thinking about."

Lambeth Hochwald is a New York City-based journalist who covers health, relationships, trends, and issues of importance to women. She's also a longtime professor at NYU's Arthur L. Carter Journalism Institute.

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