Bedside manner

Time spent brushing up on your bedside manner will never go amiss and will stay with you throughout your career. Consultant anaesthetist Leyla Sanai uses her own experience of being a patient to give some tips

Having been a patient many times, I can say that as a patient your priorities are different to those of the doctor. The conscientious doctor will want to be competent and efficient in his or her history taking and examination, and to have requests for tests sent off as quickly as possible. As a patient my criteria for a good doctor were more to do with how they treated me. When you are feeling grotty and sick or are in pain, or are worried, you appreciate kindness and consideration more than academic brilliance or clinical acumen. Of course, you greatly value these as well, and an empathetic, sweet doctor who was useless at the job would not be much use, but the need for a good bedside manner cannot be overstated.

Treating your patients the way that you would want to be treated yourself is a solid starting point. There are also specific areas which are important in establishing and maintaining a good doctor-patient relationship. Here are some tips.

Be courteous
No matter how harassed or overworked or tired you are, be polite to your patients. Always take the time to say hello and to ask permission before you examine them or dive on them with needles and syringes. Always look up and establish eye contact when a patient walks into the room or when you approach them on the ward, and address them by their name. Do not assume that you can use first names with elderly patients unless they tell you to do so. When taking the patient's history, do not just hunch up over your notepad and scribble; make sure you glance up from time to time and give the patient an encouraging smile or nod.

Be friendly
Patients are often worried when they are in hospital or in their GP's surgery. A smile and friendly comment can be very reassuring. If you sit there looking po-faced and solemn, they may assume wrongly that they are desperately ill. Of course, you have to be judicious in your choice of approach--joking and bantering would be inappropriate in dealing with a critically ill patient, or when you are about to break bad news. Use your intelligence and sensitivity.

Listen
Listening to the patient seems so obvious, and yet is so often neglected. Sometimes it is because the doctor has memorised the entire Oxford Textbook of Medicine and assumes, arrogantly, that he or she knows the patient's diagnosis better than the patient does. At other times it is because the doctor is too distracted to really listen and jumps to conclusions. The patient knows his or her own body and symptoms far better than you or any medical textbook. It was a wise doctor who said, "Listen to your patients and they will tell you the diagnosis."

Be respectful
When you are doing something day in and day out it is easy to forget the significance of your actions and how others interpret them. Examining patients, for instance, becomes routine to a doctor, but for the patient it is an unfamiliar, intrusive, and potentially unpleasant experience each time. Remember that each patient you see is an individual, with feelings and fears. Always ask permission before throwing back the bedclothes and exposing the patient, and make sure that the curtains have been drawn around the bed.

If demonstrating a sign to someone else, such as other medical students, ask the patient if that is all right before exposing the patient to a stranger.

Confidentiality is another area where respect is extremely important. Do not disclose details about the patient to others, and in particular, do not have salacious discussions in the pub about the scandalous social history of your patient. The walls have ears and they also have lawyers.

Communicate
Good communication is another basic essential attribute in a doctor but is sometimes lost when a doctor is busy. It does not take much time to tell a patient about the tests and procedures that you have planned for them, and it makes all the difference to them.

Do not forget to explain to the patient in non jargon, easy to understand (but not patronising) language why they are having the test done and what it may show. And remember to let them know the results.

Good communication with worried relatives is also a necessity. Anxiety and grief sometimes manifest themselves as anger. Often, when relatives complain about the treatment a patient has received, their distress could have been alleviated by talking to them and explaining things coherently and honestly.

Be sensitive
The vulnerability of the patient is something that doctors can forget too easily. Patients are frequently anxious, unaware of their diagnosis, afraid of cancer or death, worried about pain from a forthcoming operation, suffering from pain from their current condition, tired from lack of sleep (wards are incredibly noisy), hungry from malnourishment (hospital induced or otherwise), and scared about the future. Sensitivity is vital in all your dealings with them. This includes being aware of their feelings when discussing them with a gathered entourage on the ward round. Always make sure that you explain afterwards in layman's terms to the patient what you have said.

Never break bad news for the first time in front of other staff. When discussing sensitive or potentially traumatic issues, either with patients or their relatives, it is often a good idea to take a senior staff nurse in with you. Do not forget to ensure privacy in these discussions--telling relatives that their beloved is going to die while they hover at the entrance to the ward is not a good idea. Remember practical things--providing seats, organising cups of tea, and giving information about where to take death certificates and how to organise cremations may all seem far from the clinical side that you have trained for, but they are of importance to the patient's relatives.

As with everything, the best way to develop a great bedside manner is to practise. By ensuring that you try and put every patient at ease and alleviate their anxieties, you will find your communication skills and natural empathy rise automatically. There is a payback, too. When your patients smile at you and appreciate the way that you have treated them, their gratitude gives you a warm glow and reminds you why you went into medicine.

Leyla Sanai, consultant anaesthetist, Western Infirmary, Glasgow
Email: leyla.sanai@virgin.net


studentBMJ 2001;09:305-356 September ISSN 0966-6494