I pulled back the curtain, ready to meet the next patient on my hospital rounds.
“Why are you standing there?” she asked me. “Come, have a seat, let’s talk.”
Lenore could have been my grandmother. She was 77 years old, and all of 93 pounds. What she lacked in girth, she more than made up for in chutzpah. She was one of the patients from intern year who I’ll never forget.
After four years of medical school, I could recite biochemical pathways, genetic mutations and the ways all sorts of drugs work. But all the cramming suppressed most of my common sense. Perhaps manners, too.
Lenore was offering me a refresher course. How could I refuse her polite but firm invitation?
I’d never been encouraged to sit at a patient’s bedside — to stop hurrying for even a moment.
Our medical teachers put a premium on accuracy and efficiency, which became conflated with speed. Everything had to be fast.
In 2014, doctors still value speed and technical accuracy, but we also do more to consider the quality of care we give and whether patients are satisfied with it. Those goals aren’t just the right thing to do. There are often financial strings attached to getting them right.
Even so, interns today don’t sit much more often than they did back in my day.
In a recent study, Johns Hopkins researchers followed two groups of medical interns for a month and found they sat down at the bedside only 9 percent of the time.
Sitting down, which would seem like one of the simplest things to do, is the least practiced of five communication skills for doctors that Lenore would have endorsed and that research has shown can make a big difference in patient satisfaction.
The others include introducing oneself to the patient and explaining your role in the patient’s care. Touching the patient — whether it’s a handshake, a gesture of comfort or part of a physical exam — makes a difference, too.
And the old art of good conversation never goes out of style: Ask open-ended questions, like, “How are you feeling today?”
Medical educators should be role models for these common courtesies, says Dr. Leonard Feldman, the senior author of the study and director of an urban health residency program at Hopkins.
“Trainees take their cues from us,” he tells Shots. “These behaviors are what constitute ‘bedside manner.’ ” More than that, he says, sitting at the bedside projects body language that tells a patient, “I’m here for you. How can I be of service?”
Feldman prizes these basic but often overlooked human interactions in his trainees. He suggests simple solutions like making sure there’s a chair available next to every hospital bed.
During my own intern refresher course with Lenore those many years ago, I tried to sit in the chair next to her bed. She’d have none of it. “Here,” she said, patting the mattress and telling me where to park it. “Now, how is your day going?” she asked. An open-ended question. What a pro she was.
John Henning Schumann is a primary care doctor in Tulsa, Okla., where he teaches at the University of Oklahoma School of Community Medicine. He’s on Twitter: @GlassHospital
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