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

Discussion

In the context that bedside manner matters, this article presents a perspective on a collected inventory of clinical behaviors that we can call best bedside manner practices. The inventory includes strategies to establish a connection with the patient, to enhance communication, and to communicate empathy. Showing respect, listening actively, and enhancing communication as by using metaphors are included in the inventory.

Teaching empathy and communication to caregivers has received increasing attention as the primacy of patient experience has become better appreciated. Experience shows that both empathy and communication can be taught[14,16] and enhanced. Although this article is to our knowledge the first to develop a full inventory of bedside manner strategies, prior work has focused on various aspects of bedside manner. For example, Mabeck and Olesen[10] explored patients' use of metaphors to enhance their understanding of medical conditions. In interviews with patients in a Danish general practice, a variety of metaphors regarding pump and pressures, directions, transportation, and containers were described. Olweny[12] and Arroliga et al[11] have described physicians' use of metaphors to explain cancer therapeutics and pulmonary care. In an earlier report to capture best practices in humanistic care, Weissmann et al[1] interviewed 12 clinical faculty deemed by residents to be excellent teachers of humanistic care regarding their practices. An inventory of such humanistic practices included nonverbal communication, overt demonstrations of respect, building a personal connection, eliciting and addressing patients' affective response to illness, and the attending's being self-aware. All of these practices were communicated to trainees by modeling behavior[5] rather than by naming the practice or teaching it overtly.

Much as Taylor et al[22] described teaching professionalism using an emotional intelligence model, so too do we believe that bedside manner can and should be taught explicitly rather than only through an informal curriculum.[5,16] Although the practices that are described here were either directly observed by one of us, described by respected clinician colleagues, or in a few instances published, teaching bedside manner with an explicit curriculum is easy to imagine. Simulations and role-playing, perhaps with simulated patients, lend themselves to teaching bedside manner, just as they do to teaching communication skills. Indeed, as described by Boissy et al,[16] communication training has been widely deployed at the Cleveland Clinic, where every caregiver participates in a basic course, with more advanced modules (eg, end-of-life communication) available. Such training has been associated with significant improvements in patients' experiences.[16]

In summary, we offer an inventory of bedside manner practices in the hope that these can be incorporated into curricula for teaching the art of medicine. As each is an expression of care, each practice calls upon and must be grounded in the physician's authentic caring.[4] We submit that each of these practices can be taught explicitly and that explicit instruction would enhance the way that bedside manner has been taught traditionally.

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