Bedside manner and beyond

How compassion could revolutionise health care

(Photo: Pexels)

When Danielle Clark had a melanoma removed at just 25, her dermatologist stated her life expectancy in a cold and clinical manner.

“She said to me three times in a row, ‘You have a 95 per cent chance of living the next five years,’” says Ms Clark.  “Putting it into that terminology made me feel physically sick.”

Although the doctor believed she was relaying good news, Ms Clark found it hard to see it that way.

“I was so sick of hearing that phrase like it was a good thing,” she says.  “It makes me feel anxious when they talk about the longevity of having a melanoma at such a young age.”

While receiving quality clinical treatment is undeniably important, when a health practitioner’s bedside manner is lacking, it can have a significant effect on patients.

For Dr Stephanie Manning, a senior clinical registrar at Hutt Hospital in New Zealand, forming positive relationships with her patients is just as important as the diagnostic part of being a doctor.

“Patients tell you things that they are quite embarrassed to tell you,” she says.  “If they don’t trust you or like you, then they won’t tell you lots of important information, so I think it’s one of the most important parts of being a doctor.”

She says, however, that all too often patients feel as though they have to forgo friendly interaction for expert care, particularly in her field of surgery.

“A lot of surgeons have terrible bedside manner, and they’ve been able to get away with that for a really long time just because people need their service.”

(Video: Ashley Wallace)

Offering compassionate health care may seem low on the list of priorities when there are many patients and few hospital beds, but doing so could actually help to ease the pressure on busy health practices.

In March, Martin Bowles, Secretary of the Federal Department of Health, announced that consumer involvement in health will play a large role in delivering a better Australian health system.

In his address to the Consumer Health Colloquium, Mr Bowles stressed the importance of listening to the views of consumers, particularly as an ageing population means more people are coping with chronic diseases.

“Putting the needs of consumers at the centre of our service delivery will not only make life easier for the patients, but should produce efficiency and financial advantages for the health system,” he said.

If Australians are to play a more active role in their own health care, this can still start with our health professionals.  There is increasing evidence to show that doctors practising compassion can dramatically aid a patient’s recovery, and how they take care of themselves after they’ve left the health practice.

In other words, bedside manner matters.

How important is compassion?

Perhaps nobody knows the importance of practising empathy in medicine better than Dr Robin Youngson, co-founder of Hearts in Healthcare, a movement campaigning for more compassionate health care.

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(Infographic: Ashley Wallace)

Dr Youngson’s review of research from around the world has told him that patients who are treated with compassion trust their doctors and are more likely to follow advice, take their medication, adopt healthy lifestyle changes, and are less likely to need pain relief and hospital care following surgery.

The evidence shows that bedside manner is not just about making patients feel comfortable during treatment, but also affects their recovery once they leave the hospital or medical practice.

So what can be done to promote more compassionate health care?

Understandably, medical school plays an enormous role.  Training in doctor-patient interaction can vary for medical schools – Dr Manning learned from a combination of role play with actors, receiving feedback from fellow students, observing senior colleagues, and of course, interaction with real patients.

But beyond actively teaching doctor-patient interaction, the environment in which a medical student learns can also shape how compassionate they will be as a doctor.

A 2016 study conducted by Sydney Medical School showed that senior doctors who apply care in all areas, not just to patients but to colleagues and students, can foster a more compassionate work environment.

This idea resonates with Morgan Brown, a current student at Melbourne Medical School, who finds he best learns how to interact with patients by being around senior doctors who are particularly empathetic and compassionate.

“The best way to learn, from my experience, is by watching, by shadowing, by being part of a team with a doctor at the head who is good at it, who has done it for years and you can emulate,” he says.  “Then practising in an environment where you are able to get very constructive feedback.”

Dr Manning believes as more young doctors graduate from medical school and enter the workforce, we’ll see compassion in health care become more of a priority.   

“Now that our younger generation are coming through, we’ve been taught a bit more about communication with patients,” she says.  “I think the paternalistic model will start to phase out.”

The paternalistic model of doctor-patient interaction refers to a relationship whereby the doctor decides what is in the patient’s best interests with very little patient participation.  But patients themselves are starting to expect more.  “People want more of the full package of care rather than someone that’s just good at operating,” says Dr Manning.

Medical students can learn bedside manner from observation (Photo: StockSnap)

Beyond training: systemic innovation

While today’s medical training can help to promote compassionate health care, it’s worth considering what innovations could be explored at a systemic level to ensure better self-care on behalf of patients.

There are certainly promising developments. For example, an initiative recently implemented by HCF involves registered nurses calling patients shortly after they are discharged from hospital to provide additional support.

The program, named My Health Guardian, was found to have reduced the number of patients being readmitted to hospital by nearly a third and saved the health fund $700,000.

The work of organisations campaigning for more empathy, such as Dr Youngson’s Hearts in Healthcare, will also likely serve to improve the doctor-patient experience and patients’ subsequent self-care and healing.

For Dr Youngson, it comes down to a simple question, one that he asked in an interview with Radio New Zealand:

“What’s the difference between fixing and healing?”

“We tend to think it’s our treatments that make patients better,” he says. “They’re really just a support to the natural process of healing.”

And if more compassion is just what the doctor ordered, let’s hope more patients start to receive a good dose of it.

If you've had a bad experience with a doctor's bedside manner, you can make a complaint with the HCCC (Video: Ashley Wallace)

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