Bedside Manner 2020: An Inventory of Best Practices

Sami Abuqayyas, MD; Christopher Yurosko, DO; Ambreen Ali, MD; Christopher Rymer, MD; James K. Stoller, MD, MS

Disclosures

South Med J. 2021;114(3):156-160. 

In This Article

Abstract and Introduction

Abstract

Bedside manner, a doctor's deportment with a patient, encompasses all aspects of the patient interaction, including all verbal and nonverbal communication strategies. Bedside manner can be a powerful adjunct for healing. In academic medical centers, trainees generally learn bedside manner by observing their attendings and mentors—in other words, as part of the "hidden curriculum." Because bedside manner is a critical component in the art of healing, it can be threatened by pressures on time in managing inpatients and by the explosion of technology. This article assembles an inventory of best bedside practices for inpatient care. Eight best bedside practices were identified by reviewing the literature, collecting the personal experiences of the authors, and consulting a group of attendings whom the authors regarded as exemplary clinicians. This inventory is presented with the goal of expanding clinicians' repertoire of best practices and encouraging explicit teaching of these practices to optimize care.

Introduction

A doctor's manner with his or her patient is a time-honored asset in healing.[1–3] The bedside manner has been defined as a doctor's deportment with a patient that, for the sake of an inventory of best practices, encompasses all aspects of the doctor-patient interaction, including the physician's specific behaviors (eg, how the patient is greeted, where the physician is positioned) and both nonverbal and verbal communication strategies. Of course, these behaviors reflect the underlying commitments and attitudes of medicine at its best—empathy, compassion, and caring. The primacy of bedside manner as an essential aspect of care reflects Francis Weld Peabody's statement that "the secret of the care of the patient is in caring for the patient."[4]

In academic medical centers, often bedside manner is a modeled behavior that is taught as part of the "hidden" or informal curriculum for students and trainees—ie, taught by behaviors or underlying organizational values rather than through a formal, presented curriculum.[1,5,6] In the specific context of caring for inpatients, bedside manner regards the way doctors engage the patient who is hospitalized (and often their families), the patient about to return home, or the patient newly home after hospitalization. Although a caring bedside manner can promote healing,[1–3] current trends in inpatient care pose challenges to practicing optimal bedside manner. Temporal pressure on length of stay and an increase in the number of patients cared for may shorten interaction time and hinder the maturation of physician-patient relationships. For medical trainees, work-hour ceilings may cause more frequent transfers of care and impede the continuity of care. Finally, the increasing reliance on technology in clinical care (eg, substituting the echo probe for the stethoscope) may inadvertently lessen a doctor's interaction with a patient. Furthermore, informal curricula, which are based on individual clinical-educators' personal practices, can be idiosyncratic and may not be retained by learners.[5] With an informal curriculum, the learner can only see the attending's behavior but is offered no insight into the rationale or principles that underlie the behavior.

In the hope of reaffirming the critical nature of superb bedside manner in current clinical care, preserving best bedside manner practices and making such practices explicit and broadly available, this article is an inventory of best bedside practices that were assembled in several ways: the authors' collective observed experiences, a survey of respected clinicians at our institution, and a literature review (using OVID, surveying 1946–March 25, 2020) using the search terms "bedside manner," which yielded 130 publications. These sources yielded eight discrete best bedside practices, which are discussed below.

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