Bedside manners

When I was still active in the training of our young doctors, I would emphasize the important role of good “bedside manners” in the success of a medical practitioner. Unfortunately, it is not something that is formally taught in medical school, where the focus is more on the science rather than the art of medicine.

“Bedside manners” is a skill a physician has to learn on his own; and on many occasions, he has to learn from his own mistakes.

I recall in my first few weeks of private practice, a young lady came to see me due to uncontrolled high blood pressure. I asked her a lot of questions to get her medical history; and without even checking her marital status, I asked tactlessly, “Are you taking contraceptive pills?” (Hormonal pills are known to raise the blood pressure).

Taking it as an affront to her dignity, she reacted unfavorably. She immediately stood up, and told me, “How dare you ask me that question, doctor. Can’t you see in my chart that I’m still single!” She stormed out of my small clinic in front of the Philippine General Hospital, leaving me and my secretary flabbergasted. I realized the booboo I had just committed, and told myself I’d charge it to experience. Minutes later, she came back, slowly opened the door to my clinic, and asked me: “Doctor, do you recommend I discontinue taking contraceptive pills?”

That patient is now a happy grandmother of four, based in the United States. She comes back every now and then and she drops by at the clinic for a checkup before she travels back to the States. I’m sure she still remembers the blunder I committed at her first visit; and I’m glad she gave me a second chance.

Patient’s satisfaction

Equally important as the doctors’ and other healthcare providers’ medical knowledge and skills, their bedside manners determine their patients’ satisfaction and impression of how good their physicians are. Time and again, I’ve seen highly knowledgeable, skilled and competent physicians who are perceived unfavorably by their patients because of bad bedside manners. These patients decide to transfer to another physician, who may not be as competent as the first, but who has much better bedside manners. And the patients and their relatives feel much happier with their physician who appears to have mastered the art of medicine.

A physician who does all the talking, sometimes “sermoning,” is not really making his patients pleased with his service. Patient satisfaction is better if patients are allowed and encouraged to express their concerns, and participate in the decision-making process about their treatment.

“Good bedside manners” is not plain simple professional etiquette. It encompasses physicians’ interactive skills that help them establish respectable and mutually beneficial relationships with patients and other healthcare colleagues.

Physicians who may have acceptable bedside manners with their patients but who treat the nurses, other hospital staff and junior colleagues like they belong to a much lower professional category are unfortunate professionals. They’re like apples who look fresh and delicious on the outside but are rotten inside.

To a great extent, the practice of medicine is based on trust and confidence, which build up the patients’ faith that they will get well. Physicians—who have good bedside manners and are kind and empathetic—are likely to gain their patients’ confidence. The patients should feel relaxed when they’re in front of their doctors.

‘White coat’ hypertension

There is such a thing called “white coat” hypertension, described as an elevation of the blood pressure when patients see their doctors in the clinic. This is more pronounced when the patients anticipate a stern meeting with their doctors, who might even scold them for not being a perfectly obedient patient. They don’t look forward to seeing their doctor, and they’d be happy to change him or her with someone who’s more empathetic, and who’s more gentle and careful with the words he or she says.

The importance of developing good “bedside manners” extends to all professional fields.

And that includes public officials. I believe it’s not late for President Aquino to learn some lessons on proper “bedside manners,” not only to boost his personal stock, but also to remove the unfair perception of many that he does not really mean what he says.

His speech during the Pope’s visit rebuking the bishops was perceived to be uncalled for or “unpresidential”—very much like a doctor telling an assembly of colleagues in a scientific convention about how foolish and thoughtless his/her patients are. It was not relevant for the occasion and does not serve any meaningful purpose. His reported behavior and not-too-tactful statements during his recent meeting with the families of the 44 Special Action Force troopers also indicate that his “bedside manners” is one area requiring some improvement if he wants to be remembered favorably after his term, which is just rightfully so, considering the things he has accomplished for the country during his term.

One good guide we can always remember about “bedside manners” is that: “It’s not what one says but how one says it. It’s not what one does, but how and when one does it.” One who has sincere empathy for others will know how to say and do things by just taking a pause and listening to his or her inner voice before uttering a word or carrying out even the smallest act.

I’ve always been a big supporter of President Aquino and I remain so. Bedside manners require good communication skills. President Aquino is not lacking in communication skills. In fact I find him very eloquent. But sometimes, one’s eloquence and facility with a language could be unwittingly used the wrong way. That person is like Tiger Woods who still has a lot of good golf skills in him, but who just needs to change his swing.

I’d like President Aquino to finish his term and be rightfully credited for the gains the country has made with him at the helm. That would be a great tragedy if all his accomplishments would be forgotten and what would be remembered would be his knack to say the right things at the wrong time and with a wrong expression, and do the right things at the wrong time and at the wrong event. Whether you call it poor statesmanship, or poor “bedside manners,” something needs to be done to improve it.