He was an old Italian gentleman with a complex medical background. An acute diarrheal illness brought him to the hospital, but his chronic issues had flared up keeping him in the ward for another week. He was angry and frustrated.
As soon as I entered the room, he exploded, “Check me and send me home. Do you have any idea how many things I have to do at home?”
This was my first encounter with him. I looked at him blankly, as I was trying to understand what was going on inside him. He sounded baffled. I sat quietly at his bedside, gave him a little more time to vent. Eventually, he leaned forward and said with yearning, “Listen! I want to go to my granddaughter’s graduation and a Father’s Day dinner tomorrow.”
I replied, “Why not? We can make some arrangements for a day pass while we work on your discharge planning.”
“Can I really do that?” he asked in amazement. He appeared to be a little child who wanted to go to a toy store.
I left him with excitement to make arrangements for the day pass.
My patient was able to attend both events and was very thankful to the team who managed his care plan while he was out of the hospital. I sat with him for 10 minutes to listen to how the events went. He enthusiastically started to give the details of every step. His face was glowing, and his eyes were shining while he talked about his loved ones.
To add to his delight, I gladly announced, “You are going home tomorrow because we’ve arranged IV antibiotics for home.” He looked at me and exclaimed, “Are you sure this is not a joke?” I laughed and left his room to let him enjoy the moment.
The next morning, I got the news that he had fallen overnight and fractured his arm. It was a non-operable injury, and he required rehabilitation to be functionally independent at home. It was now time for me to sign the patient over to another care team. I jogged to his room and sat down at his bedside.
There was nothing in his eyes other than darkness and frustration. He was resentful yet thankful, a surprising and unexpected response. He said, “You talked to me for a long time the other day and tried your best to get me home. That day, I felt refreshed for the first time in several days. I want to tell you one thing. Doctor, you make me feel better every day!” he exclaimed. “Please stop by later to say hi if you can!” he requested.
He made my day, yet his response left me with the question: What did I do differently?
One of the core clinical skills to practice in medicine is to develop excellent communication. The conversation does not necessarily need to be detailed or even relevant. Kneeling at the bedside and asking the patients about their experience in the hospital reflects that you care about them.
Often patients do not just need evidence-based medicine to appreciate healthcare as much as they need etiquette-based medicine, which is demonstrated when a physician is respectful and attentive and practices good manners.1 A patient needs a good and active listener with interpersonal skills. Effective doctor-patient communication is determined by the physicians’ bedside manner, which patients judge as a major indicator of their doctors’ general competence.2
Terry Canale in his American Academy of Orthopedic Surgeons Vice Presidential address said, “The patient will never care how much you know until they know how much you care.”3
We in healthcare know that intense medical training and burn out, particularly during residency, suppresses empathy and often results in derision of patients.4 We are not born with this skillset; we learn it through our experience and exposure. Empathy is one of the most powerful ways to support our patients, reduce their feelings of isolation and validate their thoughts as normal and to be expected.5
As physicians impacting patient experience, there is nothing to do significantly different in healthcare than to spend a few more minutes acknowledging patients’ concerns and helping them realize we care about them. We need to honor our patients’ autonomy and dignity by considering them first as human beings and then as patients. Training for an etiquette-based approach to patient care would complement rather than replace training of physicians to be more humane.1. It is a critical core competency that as resident physicians we are expected to achieve.
1- Kahn, M. Etiquette-based medicine. N Engl J 2008;358:1988-89.
2- Hall JA, Rotes DL, Rand CS. Communication of affect between patient and physician. J Health Soc Behav. 1981;22(1):18-30.
3- Tongue JR, Epps HR, Forese LL. Communication skills for patient-centered care: research-based, easily learned techniques for medical interviews that benefit orthopaedic surgeons and their patients. J Bone Joint Surg Am. 2005;87:652-658.
4- DiMatteo MR. The role of the physician in the emerging health care environment. West J Med. 1998;168(5):328-333.
5- Ha JF, Anat DS, Longnecker N. Doctor-Patient Communication: A Review. The Ochsner Journal. 2010;10:38-43
For more information, contact:
Sidra Javed, FRCPC, M.B.B.S: PGY5, General Internal Medicine
Cumming School of Medicine, University of Calgary, Canada
Dr. Sidra Javed is a General Internal Medicine fellow at the University of Calgary, Canada. She graduated from Pakistan and had the opportunity to closely observe cultural differences that shape a patient care approach. She is a strong advocate of patient safety and healthcare quality improvement by evaluating organizations through the lens of a person/family that needs care and service. She is embracing patient and family involvement in decision making and gaining further skills through People-Centred Care Leadership program offered by Canadian Healthcare Association (CHA) Learning, a division of Healthcare Canada.