Doctors return to school in the name of bedside manner

[Guest guest]

Stolen from another list.

http://www.oregonlive.com/news/oregonian/index.ssf?/news/oregonian/lc_12pati

e10.frameYoung

doctors return to school in the name of bedside manner

New surgeons test a seminar at OHSU that teaches them how to be more

empathetic and attentive to patients

Sunday, June 10, 2001

------------------------------------------------------------------------By

Trevison of The Oregonian staffThe patient was in tears by the

time her doctor backed away. He'd started out pleasant and funny. But

then he blasted the 17-year-old soccer player with doc talk about

whether her " ACL " was a " total " or a " partial, " and glossed over her

obvious anguish as he rattled into the surgical technique he might use

on her knee.

" When he got into trouble and her face started to crumple, he ignored

that, " orthopedic surgeon Tongue told a group of young doctors as

they analyzed a videotaped re-creation of the encounter Saturday at

Oregon Health & Science University. As the patient started losing her

composure, Tongue said, the doctor " looks like he's beating a hasty

retreat. "

Arrogant. Elitist. Cold. That's the rap on doctors -- at least until

they start expressing concern for their patients, Tongue said.

Ironically, the education that teaches medical students how to help

patients might actually stunt their people skills, Tongue said. One

study showed medical students were better at talking to patients at the

beginning of their schooling than at the end.

That's why Tongue and OHSU spent Saturday field testing a new Bayer

Institute seminar for the American Academy of Orthopaedic Surgeons --

one that teaches young doctors the finer points of speaking to patients

with attention and empathy.

After talking to a patient, " I have a vague sense that sometimes this

could have gone better, " said senior resident Hayden, who in four

years of medical school and five years of residency was never offered a

class in good doctor-patient communication.

The young doctors all had patients they dreaded dealing with -- the ones

who were rude and demanding, the ones with hate tattoos and the ones

with hidden motives such as getting workers' compensation or a

prescription for narcotics.

Hayden is especially troubled by " the highly emotional patient -- the

one who breaks down and cries. I think, 'OK, I'll come back when you

finish your tear fit,' " he told his colleagues Saturday.

" For the most part, I tend to be the surgeon -- 'Let's get into the OR,

let's fix it,' " he added later.

Years ago, many patients and doctors thought that was enough. But these

days, patients know more. They have higher expectations, they're more

likely to sue and they insist that doctors show interest in their lives.

Doctors, on the other hand, are under pressure, both from the demands of

managed care and the need to understand more advanced medicines,

instruments and techniques.

" Maybe it's the emphasis that we at the medical schools put on this big

scientific education, and their scores in scientific subjects, " said Dr.

Bird, chairman of OHSU's department of orthopaedics and

rehabilitation. " Are we selecting out for people who don't have the

people skills? "

Most medical education is aimed at finding and fixing problems rather

than communication, said University of Chicago medical professor

Levinson. But research shows doctors need both.

" You can be a brilliant diagnostician, but if patients don't understand

you, don't believe you, don't trust you, it won't do any good, " Levinson

said.

The class started simply, concentrating on ways to engage patients. Make

eye contact while shaking hands, Tongue suggested. Ask patients about

their lives. Use words like " welcome " and a pleasant, consistent tone of

voice.

Tongue has stopped asking, " How are you doing? " which almost forces

patients to answer, " Fine, " even if they're not, he said. Instead, he

asks, " How can I help you? "

Studies show the average doctor butts into the patients' stories after

18 seconds, he said. Tongue advised his class to shut up and listen. If

doctors let patients tell their story for two minutes, they may find out

most of what they need to know quickly and efficiently, while making the

patient feel understood, he said.

The doctors used role-playing to work on listening to and educating

patients, and enlisting their help in treatment. Many of the doctors

already had developed strategies to help patients understand. Dr. Ali

Motamedi said that although he's not a great artist, he draws sketches

to help people understand certain injuries -- concepts such as how their

anterior cruciate ligament connects the thigh bone to the shin bone, how

the tear might be total or partial and how it can be repaired.

During these tasks, Tongue said, doctors must show empathy. They

shouldn't ignore a face filled with sorrow or fear. They should reassure

patients about feelings and situations that are normal.

" I think it does take energy to show interest in your patients as an

individual, " Tongue said, " but once you really understand that it

improves their medical care, and that hopefully it will prevent

misunderstandings, people enjoy investing that kind of energy. "

[Guest guest]

They need to send some of those new and improved doctors my way.

Sheryl

[ ] Doctors return to school in the name of bedside manner

> Stolen from another list.

>

>

http://www.oregonlive.com/news/oregonian/index.ssf?/news/oregonian/lc_12pati

> e10.frameYoung

> doctors return to school in the name of bedside manner

>

> New surgeons test a seminar at OHSU that teaches them how to be more

> empathetic and attentive to patients

>

> Sunday, June 10, 2001

> ------------------------------------------------------------------------By

> Trevison of The Oregonian staffThe patient was in tears by the

> time her doctor backed away. He'd started out pleasant and funny. But

> then he blasted the 17-year-old soccer player with doc talk about

> whether her " ACL " was a " total " or a " partial, " and glossed over her

> obvious anguish as he rattled into the surgical technique he might use

> on her knee.

>

> " When he got into trouble and her face started to crumple, he ignored

> that, " orthopedic surgeon Tongue told a group of young doctors as

> they analyzed a videotaped re-creation of the encounter Saturday at

> Oregon Health & Science University. As the patient started losing her

> composure, Tongue said, the doctor " looks like he's beating a hasty

> retreat. "

>

> Arrogant. Elitist. Cold. That's the rap on doctors -- at least until

> they start expressing concern for their patients, Tongue said.

> Ironically, the education that teaches medical students how to help

> patients might actually stunt their people skills, Tongue said. One

> study showed medical students were better at talking to patients at the

> beginning of their schooling than at the end.

>

> That's why Tongue and OHSU spent Saturday field testing a new Bayer

> Institute seminar for the American Academy of Orthopaedic Surgeons --

> one that teaches young doctors the finer points of speaking to patients

> with attention and empathy.

>

> After talking to a patient, " I have a vague sense that sometimes this

> could have gone better, " said senior resident Hayden, who in four

> years of medical school and five years of residency was never offered a

> class in good doctor-patient communication.

>

> The young doctors all had patients they dreaded dealing with -- the ones

> who were rude and demanding, the ones with hate tattoos and the ones

> with hidden motives such as getting workers' compensation or a

> prescription for narcotics.

>

> Hayden is especially troubled by " the highly emotional patient -- the

> one who breaks down and cries. I think, 'OK, I'll come back when you

> finish your tear fit,' " he told his colleagues Saturday.

>

> " For the most part, I tend to be the surgeon -- 'Let's get into the OR,

> let's fix it,' " he added later.

>

> Years ago, many patients and doctors thought that was enough. But these

> days, patients know more. They have higher expectations, they're more

> likely to sue and they insist that doctors show interest in their lives.

> Doctors, on the other hand, are under pressure, both from the demands of

> managed care and the need to understand more advanced medicines,

> instruments and techniques.

>

> " Maybe it's the emphasis that we at the medical schools put on this big

> scientific education, and their scores in scientific subjects, " said Dr.

> Bird, chairman of OHSU's department of orthopaedics and

> rehabilitation. " Are we selecting out for people who don't have the

> people skills? "

>

> Most medical education is aimed at finding and fixing problems rather

> than communication, said University of Chicago medical professor

> Levinson. But research shows doctors need both.

>

> " You can be a brilliant diagnostician, but if patients don't understand

> you, don't believe you, don't trust you, it won't do any good, " Levinson

> said.

>

> The class started simply, concentrating on ways to engage patients. Make

> eye contact while shaking hands, Tongue suggested. Ask patients about

> their lives. Use words like " welcome " and a pleasant, consistent tone of

> voice.

>

> Tongue has stopped asking, " How are you doing? " which almost forces

> patients to answer, " Fine, " even if they're not, he said. Instead, he

> asks, " How can I help you? "

> Studies show the average doctor butts into the patients' stories after

> 18 seconds, he said. Tongue advised his class to shut up and listen. If

> doctors let patients tell their story for two minutes, they may find out

> most of what they need to know quickly and efficiently, while making the

> patient feel understood, he said.

>

> The doctors used role-playing to work on listening to and educating

> patients, and enlisting their help in treatment. Many of the doctors

> already had developed strategies to help patients understand. Dr. Ali

> Motamedi said that although he's not a great artist, he draws sketches

> to help people understand certain injuries -- concepts such as how their

> anterior cruciate ligament connects the thigh bone to the shin bone, how

> the tear might be total or partial and how it can be repaired.

>

> During these tasks, Tongue said, doctors must show empathy. They

> shouldn't ignore a face filled with sorrow or fear. They should reassure

> patients about feelings and situations that are normal.

>

> " I think it does take energy to show interest in your patients as an

> individual, " Tongue said, " but once you really understand that it

> improves their medical care, and that hopefully it will prevent

> misunderstandings, people enjoy investing that kind of energy. "

>

>

>

>

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