Healthcare is both a retail service and a place for the delivery of clinical care. Customer satisfaction scores and patient complaints and malpractice suits are making the practice of medicine a very unique experience. The independent physician needs some tools such as unique bedside manner skills to navigate this.
How should the modern physician behave at the bedside? There has to be a balance so that we don’t get more jaded and recover from burnout.
Independent Physician vs the Employee
A large medical group has a reputation to uphold. Their goal is to make money and minimize their risk exposure. Customer satisfaction is their goal, motto, and metric.
Conversely, the independent physician, someone who has their own practice, is more focused on patient health and career satisfaction.
These are generalizations and exceptions are common. I can’t imagine a physician going into private practice to make themselves suffer. The main motivation often is the lack of autonomy and perverse incentives we experience in mainstream settings.
Risks of Practicing Medicine
The reality is that for the number of patients we see and how much goes wrong, we aren’t sued as often as we could. This is a sad statement to make but maybe it’s a way to delude me into passivity.
Practicing medicine in this era has the following risks:
- compassion fatigue
- defensive medicine
- medical board complaint
Burnout, of course, is depression and substance abuse, insomnia, and disconnection from reality.
Compassion fatigue means you get jaded and stop caring about yourself and your patient. The patient is another hurdle to a paycheck.
A malpractice suit is often settled out of court but you are still caught up in it. And physicians fear this process because we aren’t familiar with it.
A medical board complaint can lead to a job loss or losing faith in your abilities as a physician.
Developing a Solid Bedside Manner
Only a few years ago I practiced a very bold bedside manner; very intentional and defensive but friendly. This has been exhausting and I don’t recommend it.
I sometimes think that my bedside manner and defensive practice style protected me from malpractice suits. But the reality is that this is delusional. Regardless, it’s not something I can keep up any longer because it’s burning me the fuck out.
The tenets of a good bedside manner are for me are:
- being present
- good communication
- genuine empathy
- patient-centered care
1. Being Present
I am referring to being in the moment with the person and not rushing from one patient to the next. I don’t care about the line out of the urgent care door or patients upset for waiting 3 hours.
I am in this room with this patient and that’s where my focus is. It requires that I drop my guard and ask some warmup questions and address everyone in the room.
I listen, I ask questions, and I reply. Then I ask if there is something else on their mind. There usually isn’t and when there is, then I continue to be present.
2. Good Communication
I need to listen first so I know what the patient is really here for. It’s often not what they complain about. There is often something else underlying the reason for their visit.
To communicate well I need to learn how this patient communicates. Do they feel that I addressed their concerns?
I want them to know what I’m doing for them, what I think is going on, and what to do in case the outcome is anything other than what I expected.
3. Genuine Empathy
Empathy I learned in medical school is parroting back what the patient said. “I hear you are upset that you have yet another yeast infection.”
Genuine empathy is putting myself in their shoe to ask the questions they didn’t think to ask. And perhaps offer insight from the perspective of that person if they could feel more vulnerable but safe.
Often just a pause, talking slowly, and not talking as much shows genuine empathy.
4. Patient-Centered Care
The virus vs bacteria and the opioid conversations is… exhausting. I haven’t succeeded much other than burning myself out and pissing off patients.
But I will still make the effort because that’s why I’m a doctor. If I don’t and only cater to the customer service metric then it’ll be like when I was an employee; burnout and jadedness will be right around the corner.
My allegiance is with the patient. But I won’t sacrifice my well-being for the patient. I never signed up for that.
I believe that the patient will be fine without sutures, antibiotics, and pain medication. I care enough that I’ll explain my stance and address their concerns. If they don’t agree and I can justify the prescription, I’ll prescribe it.
I am not a humble person so this is a skill in the process but I’m improving. Being humble means I admit that I know less than I think I do. I am also likely going to make many mistakes every day.
Humbleness means I’ll apologize right away or as soon as I can. I’ll change my stance as soon as I feel it’s no longer a valid position to hold.
Being humble means leaving my ego at the door. I am going to be more of myself which some days is quite a miserable human being and other days it’s a lovely person I’d like to be friends with.
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