COMMENTARY

A Better Bedside Manner Can and Should Be Taught

Prashant Vaishnava, MD

Disclosures

July 30, 2015

Earlier this year, I accepted the role of quality officer at my institution. One of my responsibilities is to help monitor and improve our hospital's performance on patient satisfaction. The patients' perspective on the quality of healthcare is becoming increasingly integral to the consistent delivery of high-quality, efficient, and value-based care.

Since 2008, the Centers for Medicare & Medicaid Services (CMS) have conducted the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.[1] This is a 32-item survey instrument for measuring patients' perceptions of their hospital experience; it is administered to a random sample of adult inpatients between 48 hours and 6 weeks after discharge.

Eleven HCAHPS measures are publically reported, including the following composite measures:

  • How well nurses and doctors communicate with patients;

  • How responsive hospital staff are to patients' needs;

  • How well hospital staff help patients manage pain;

  • How well the staff communicates with patients about their medicines;

  • Whether key information is provided at discharge; and

  • How well patients understood the type of care they would need after leaving the hospital.

Not only are HCAHPS scores publically reported, but they are also a component of the hospital value-based purchasing program, through which payment from CMS is linked to performance.

Undoubtedly, there is an imperative to improve the patient experience. Within our institution, just as in others nationally, there are opportunities for improvement. Improving patient satisfaction is complex and multifaceted, involving many moving parts and interconnected priorities—refinement of team dynamics, well-coordinated interdisciplinary interactions and rounding, successful transitions of care, and an emphasis on customer satisfaction at all levels, just to name a few.

Why is it so difficult to achieve patient satisfaction when our capabilities and technology are otherwise so advanced? We have an armamentarium of new medications and cutting-edge technologies, yet we lag behind in communicating with and responding to our patients.

Although I acknowledge that the solution to bettering the patient experience is not as facile as imbuing our trainees with the awareness and skills to improve their bedside manner, I am convinced that physicians and other healthcare providers can be trained to deliver patient- and family-centered care. The latest and fourth iteration of the Core Cardiovascular Training Statement (COCATS 4) was recently released by the American College of Cardiology's Competency Management Committee.[2] As an early career representative, I had the honor of participating in Task Force 1 of COCATS 4. Task Force 1, cochaired by Dr Valentin Fuster, Dr Jonathan Halperin, and Dr Eric Williams, was charged with updating guidelines for training in ambulatory, consultative, and longitudinal cardiovascular care.[3]

A major thrust of the standards published by Task Force 1 is on interpersonal and communication skills. We wrote the following about interpersonal skills: "Successful clinicians share a common asset: interpersonal skills. This is among the most difficult skills to teach because it is highly dependent on personality...The requisite skills include the ability to interpret cues from body language (including recognition of fear, anxiety, depression, and denial of illness), and to inspire, motivate, encourage, coach, and openly discuss goals of care."[3]

The development of successful interpersonal skills, such as those that lend themselves to favorable perceptions of the hospital experience, begins with exposure to mentors who can role-model such behaviors. One of my most memorable and valuable experiences from general cardiology fellowship training was being able to observe Dr Valentin Fuster in clinic and on the wards.

Cardiology fellows at Mount Sinai have the privilege of being the "Fuster Fellow" for 4-6 weeks over the course of our first 2 years of training. I tried to observe as much of Dr Fuster as I could; I learned from such subtleties as his mannerisms, the tone of his voice, the lean in his posture, cues from his body language, and his selection of words (eg, "significant" for "severe" so as to not alarm the patient). Vestiges of what I learned from Dr Fuster have been integrated into my daily clinical practice. I learned interpersonal skills by observing a mentor who was interested and able to be a role model.

I am sure that our trainees will be well served by exposure to master clinicians such as Dr Fuster. Just as we can teach our fellows to insert a transvenous pacemaker, interpret hemodynamics, or inject the right coronary artery, interpersonal skills can also be taught and learned. This is especially important in the inpatient setting, where actual "bedside teaching" is a rarity.[4,5,6,7]

And although the cocoon of the conference room or corridor may seem a tempting substitute, being far removed from the uncertainty of what questions may arise at the bedside, we do a disservice to our students and patients by not role-modeling behavior at the bedside. The patient experience can be enhanced by bedside teaching, a potential instrument through which we can transmit our humanism and demonstrate our interest in and respect for the patient. Although some may worry that bedside rounds could lead to patient embarrassment and be disruptive to a patient's itinerary for the day, patients often see rounds as an opportunity to express their feelings and are confident that bedside teaching can be performed in such a way that is respectful to them as individuals.[8]

We are faced with an imperative to improve the patient experience. The sustained execution of this mandate relies on our willingness and ability to role model behavior that lends itself to favorable perceptions of the hospital experience. Interpersonal skills can and should be taught, and when learned, they can foster positive interactions with our patients and each other.

The task of improving patient satisfaction may seem daunting, but it is clearly manageable and fundamental. As put by Francis Peabody many years ago, "The secret of the care of the patient is in caring for the patient."[9]

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