Where are your (bedside) manners?

This exploded in my Facebook network two days ago. Doctors and nurses were furiously sharing it with angry comments.

Are resident doctors really doctors? http://mindanaotimes.net/loud-whispers-are-resident-doctors-really-doctors/

I wanted to finish writing this blog post yesterday but I had to collect myself first and calm down. The author of this now viral newspaper article, is talking about THE government hospital where I trained as a resident in internal medicine. My internal medicine residency is unique in that I spent ten months in the emergency room (ER) as part of the transition batch where the ER rotation was transferred to second year residency. Thus, I rotated at the ER twice – as a first year and second year resident. I am very familiar with the setting of the story.

Much has been said about the author’s question. So I will be brief and answer YES. Resident doctors are licensed physicians. [deep breath]

About casual wear. The hospital does not provide uniforms for its resident doctors. They do have white coats. About speaking in English. The usual patients who go to the ER in this government hospital speak in Filipino, and so the doctors speak in Filipino too.

I will agree with the author that healthcare personnel should always introduce themselves. Interns have name plates but residents don’t. Maybe residents should have name plates too as they don’t often wear the hospital coat when it is too hot in the ER.

The ER never has enough doctors for the many patients that arrive. I suppose the situation remains the same. In 1997 and 1998 when I was rotating at the ER, only three residents (sometimes four) go on 24-hour duty at Internal Medicine. That would mean two three or four-hour shifts where you receive the patients that arrive. When you are not “receiving,” you are attending to the twenty or so patients you received in your shift until you are able to admit them or endorse them to the next ER team on duty the following day. Waiting times are long. We do the best that we can.

Are tempers short? Are bedside manners missing? Are doctors tired? Yes. Is there ever enough time to explain things at the ER? No. The patient experience recounted by the author is not unique or uncommon. I am upset and offended however when the author said –

I guess if this is the situation in almost all hospitals in the country, 90% or even 99% who are patients in ERs will just die because nurses and doctors are not humane to patients.

I must admit that my hospital is not well-known for the doctors’ bedside manners but we save lives. For many, this hospital is the “hospital of choice” when they are turned away elsewhere, and often the hospital of last resort. Many a resident doctor has given out his salary to pay for patient’s procedures or medications, often without the patient even knowing. They do not expect gratitude. It is simply the humane thing to do. It hurts too much to lose patients when a few pesos can easily save them.

In a previous #HealthXPH tweet chat blog post, Five-Star Hospital: Is it all about patient experience? I wrote –

Years ago, a government hospital launched a campaign – Magaling Na, Magalang Pa. Translated it means, Excellent but Courteous Too. This hospital only accepted the brightest doctors but sadly, they were not always polite or respectful. The patients who came to the hospital seemed willing to accept this. They often excused the doctors for having no time for such niceties with so many patients needing to be served. They were willing to sacrifice a gracious bedside manner in exchange for impeccable medical care. It can be argued that these patients suffer willingly as they cannot afford to go anywhere else. Because they receive free medical care, they also do not expect too much from their doctors except to get better. What do you think?

So let’s talk about bedside manners in this week’s #HealthXPh tweet chat on July 25, 9 pm Manila time.

T1 For healthcare professionals and patients, how important are bedside manners? How much do they differ in degree of importance?

From Atul Gawande –

It is unsettling how little it takes to defeat success in medicine. You come as a professional equipped with expertise and technology. You do not imagine that a mere matter of etiquette could foil you. But the social dimension turns out to be as essential as the scientific matter of how casual you should be, how formal, how reticent, how forthright. Also how apologetic, how self confident, how money minded. In this work against sickness, we begin not with genetic or cellular interactions but with human one.

T2 How should healthcare professionals introduce themselves when meeting a patient at the ER?

Dr. Kate Granger started the #HelloMyNameIs campaign. She is a doctor and a cancer patient. She has this to say –

I firmly believe it is not just about knowing someone’s name, but it runs much deeper. It is about making a human connection, beginning a therapeutic relationship and building trust. In my mind it is the first rung on the ladder to providing compassionate care.

T3 How can we convey compassion in short patient encounters at the ER?

Physicians often look to William Osler when the subject of bedside manners comes up. This essay written by Dr. Barry Silverman is worth reading – Physician behavior and bedside manners: the influence of William Osler and the Johns Hopkins School of Medicine. Proc (Bayl Univ Med Cent). 2012 Jan; 25(1): 58–61.

In this blog post Bedside Manner: The Case for Compassion, Dr. Larry Dossey an internist said –

Some say compassion is out of date. These days, physicians have only minutes to spend with patients in most medical settings. No physician can make a house call on a single patient for 40 days in a row, as Osler did. But that is not the entire story. Compassion can be conveyed in moments; it is not proportional to time.

See you at the #HealthXPH tweet chat.

This post is my opinion and does not reflect that of the institutions I am affiliated with.