bedside medicine

Bedside medicine relies on practitioners’ quelling the fears that each patient brings into the exam room. The art of medicine is thus an empathetic bedside manner. Yet, as a Family Medicine study shows, medical students are trained to avoid emotion. Even today, though, empathy is essential to practicing medicine in patients’ best interests.

1. Prepare for Stress

By its nature, clinical training leads to exhaustion and loss of empathy, as shown by Bellini, Baime, and Shea. Accordingly, a 2011 study in Academic Medicine found high burnout rates among residents. So, the first step in addressing patients’ anxiety is to recognize your own. Pay attention to your body’s signals, from a fast heart rate to tense muscles or indigestion. Then, practice patience, and take deep breaths before talking or taking action.

2. Mind Your Manners

In a 2008 article from the New England Jounral of Medicine, Kahn argues for Etiquette-Based Medicine. Studies show that good manners in bedside medicine lead to greater empathy, curiosity, and compassion. To that end:

• Enter the patient’s room only after receiving permission.
• Introduce yourself with your ID upon entering.
• Shake hands with the patient.

As a study in Hospitals and Health Networks shows, practitioners overestimate their politeness. So, err on the side of caution, and use these gestures to build a calming relationship.

3. Listen to Patients

Communication remains key in patient-centered care. Therefore Epstein argues for the core competencies of interpersonal communication and professionalism.

• On the one hand, practitioners should listen attentively to anxious patients.
• On the other, you should ask patients how they are feeling and how to help them.

In the process, practitioners should rely upon open-ended questions and patient-centered methods. Smith et al. shows that the end result is a stronger foundation for collaborative bedside medicine.

4. Empathize

When engaging with patients, put yourself in their shoes. Look at situations through their eyes, and beware your assumptions about their experiences. These biases may be conscious or unconscious, so it is important not to judge peoples’ behavior too harshly or too quickly. An International Journal of Caring Sciences article shows the results, with patients of empathetic doctors more likely to follow treatments, control conditions, and be satisfied with care.

5. Heal with Humor

While inquiring about patients’ lives is a good start, you can also use humor to defuse anxiety. Making jokes narrows interpersonal gaps by showing that both patient and practitioner are human. Furthermore, as Bennett notes, humor relieves tension by allowing for patients to express their frustrations. So, although jokes should be used with care, laughter is yet another therapeutic tool for addressing anxiety.

6. Show; Don’t Tell

Avoid telling patients to relax; instead, ask how to help. Then, demonstrate relaxation techniques like deep breathing and mindfulness meditation. As shown by Michiyo, Haruko, and Sayoko, the latter can be used to both decrease tension and improve physical symptoms. You can also create calming conditions by dimming lights, asking visitors to step out, or offering tea or a warm blanket.

7. Coordinate Care

Last, but not least, the many hand-offs of contemporary medicine make communication failures the cause of most errors. Such issues also fuel patients’ fears of this unfamiliar environment. Practitioners, however, can comfort patients by explaining each individual’s role on the healthcare team and each step in terms of the purpose behind it. In this way, coordination reassures patients at each step of care.

These methods are all oriented around the foundation of bedside medicine: empathy. Addressing patient concerns in this way ensures the success of treatment. So, you can use theses techniques to supplement support and ensure successful overall care.

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Is the physical exam dead? 

Clinical observation has been part of medicine for thousands of years, ever since Babylonian, Chinese and Indian physicians first examined bodies. Lately, however, the practice has become a rarity as technology has enhanced physicians’ ability to see and hear things that were previously hidden. 

But that doesn’t mean bedside medicine should be put to sleep. 

The value of the bedside exam

While advancements in medical technology have improved doctors’ ability to diagnose and treat certain illnesses, they have their limitations. 

CT scans and X-rays can’t feel where an abdomen is tender. They can’t perceive pained facial expressions when a particular area of a patient’s body is touched. And they can’t ask questions about a patient’s diet, physical activities and lifestyle. 

These factors can often only be examined and evaluated by a physician who understands and values bedside medicine. In fact, an effective bedside exam actually allows physicians to make better use of technology. Doctors who are skilled at bedside exams are often able to gather more and better information about their patients’ conditions, allowing for more selective use of medical technology. 

Unfortunately, the financial realities of the healthcare industry have pushed bedside medicine to the wayside. 

From the bedside to conference tables

The end of bedside medicine as a common practice can almost certainly be linked to the push for greater efficiency. 

There used to be an expectation–from patients as well as insurance companies–that doctors would spend quality time with their patients. It was, after all, the way medicine had been practiced for centuries. Physicians were trusted to take the time necessary to get to know their patients and make the best possible decisions. 

Then the bottom line got in the way. 

Insurance companies called for greater efficiency. Physicians were pressured to keep exams brief, see more patients and shorten hospital stays–all in the name of decreasing costs and increasing revenues. 

Hospitals, too, played a role in moving doctors away from the bedside and into the conference room. After all, it’s much more efficient for physicians to meet and discuss patient care and make treatment decisions around a conference table than it is to have them doing it during rounds. 

Reviving bedside medicine

There is no question that the dizzying array of high-tech, sophisticated and expensive tools and tests has put bedside medicine on the ropes and some patients have suffered as a result. 

A simple search of the Internet reveals many documented cases of patients whose conditions went untreated for long periods of time because doctors were led down the wrong diagnostic road due to their reliance on technology. 

These cases, along with calls for patients to spend more time with their doctors, are reviving the lost art of bedside medicine. It could be considered a move away from high-tech and back to high-touch medicine. 

Medical schools and teaching hospitals are working to help aspiring physicians understand both the value of bedside exams as well as how to perform them. 

They’re getting back to the basics, which include:

• feeling lymph nodes and differentiating benign enlargement from possible malignancy,
• evaluating patients’ walking for signs of neurological or musculoskeletal impairment,
• inspecting the tongue for the presence of infection,
• feeling the thyroid gland to check for enlargement,
• evaluating knees for pain and movement,
• listening to patients and their family members.  

The goal is to ensure that doctors rely less on technology and more on their ability to walk down the hall, evaluate a patient and then use the right tools at the right time–for the right reasons. 

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