Download a PDF of the Current Issue 2015 Volume 12 Number 3 July- September
1.) A young mother of three children waits patiently to be evaluated by the community’s most respected colorectal surgeon. She is beleaguered by symptomatic hemorrhoids, the residual of three pregnancies. The surgeon is very pleasant and performs a thorough examination, after which he lists all of the options available for the patient to choose as therapy for her problem. The young woman is not a doctor and has little association with the health care profession. She has no idea which of the options presented to her would be the most suitable to her situation and is left in a quandary because the physician, despite his pleasantness and obvious concern, would not commit to a specific recommendation for her care.
2.) A young father looks in shock as his three-year-old son fights for life in an intensive care unit. His little boy is trying to recover from massive injuries sustained in an automobile crash that killed his wife.
Many physicians, nurses, and other health care professionals are scurrying about. The child is obviously the center of an enormous amount of intensive and expensive technology, each element of which brings an expected benefit and an accepted risk. The father talks to the physicians on the health care team. He listens, but does not hear.
His ability to understand and comprehend is almost completely supplanted by grief at the death of his wife.
3. In a busy clinic, a well-respected surgeon introduces himself to a new patient, discusses briefly the patient’s concerns, examines the patient, and then informs the patient that the resident team will be arriving shortly to complete a full evaluation in preparation for the recommended surgical procedure. The busy surgeon then goes on to the next patient.
Each of these scenarios represents a combination of good and bad. Physicians today are overwhelmed by increasing administrative stress, decreasing levels of reimbursement, and a variety of other factors, all of which compete effectively for the most valuable asset any physician possesses – his or her time. In the first case, the community surgeon, having previously encountered the uncomfortable end of litigation, is not willing to commit to a specific recommendation for fear that his recommendation would not be agreeable to the patient and that any adverse results would result in litigation or at least complaint. That physician, despite his obvious care and compassion and the respect that he enjoys from patients and peers alike, has not really met his patient’s needs. What his patient needs is the benefit of his expertise to make a recommendation based on his professional assessment.
The second scenario is even more challenging. There are many physicians, all of whom are distracted by a variety of different issues, attempting to provide integrated, multi-disciplinary care while maintaining some degree of liaison with the family. This circumstance represents a very common problem in increasingly sophisticated health care facilities where multiple specialists co-manage patients and provide varied insight to family members from differing physiologic and anatomic perspectives. This case, like the first, needs a lead physician who combines compassion and comprehensive understanding to provide a central source of information to families who are, by definition, in crisis.
Consultants bring special expertise to the bedside but must remember that their input should complement, rather than contradict, the message of the rest of the health care team. Adding more confusion to families in crisis does nothing but undermine confidence, exacerbate fear, and increase frustration. Regardless of clinical outcome, these become the building blocks of patient dissatisfaction.
The third case is all too common in academic health care environments. Effective graduate medical education requires that trainees have an opportunity to interact with the patients of attending clinical faculty. At the same time, the attending faculty member must remain fully identified and involved as the leader of the health care team. The patient must be assured that an accomplished and experienced attending physician is responsible for the patient’s care, and that care will be in concert with the physician trainees. Remember, most patients have absolutely no idea how doctors are trained!
With respect to bedside manner, the common thread we want to exhibit is compassion, concern, and effective communication. Each patient is different; each scenario is different, as is the level of stress that distracts from effective communication. Thus, when one looks at the process of determining a relationship in which a physician identifies himself or herself as the individual who will be responsible for a patient’s health care, one must understand that this is the establishment of a unique relationship based on confidence and communication. Good bedside manner does not necessarily mean playing the role of “best buddy” with every patient. It does mandate, however, that the physician primarily responsible for a patient’s care be known to the patient, and that this physician communicates effectively with the patient. Demonstrating genuine concern regarding the patient’s welfare and commitment to the patient’s care will establish a relationship of trust and reliance that will withstand the confusion of modern health care delivery. Too often, the hierarchal design of academic medicine undermines this critical part of an effective physician-patient relationship.
The more complex the situation, the more likely that increasingly invasive technology may yield adverse, as well as successful, results. In these times of continued stress, the attending physician must commit enough time to identify himself or herself as the leader of the team. If nothing else, this illustrates to trainees that the practice of medicine is a combination of art and science, and that the primary goal of all practitioners is the well-being of their fellow man, regardless of the adversity of the environment. 
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