Bedside Manner? How do you define it? And how important is it?

Dr Gary
By Dr GaryCA Latest Reply 2011-07-23 12:19:15 -0500
Started 2011-06-09 14:04:02 -0500

Here on Diabetic Connect, we often share experiences about doctors who we feel connected to as well as those we don’t.

I often talk to people about their relationships with their physicians. I hear stories about really caring, concerned doctors who encourage their patients to talk about what’s going, who ask questions and answer questions, who offer words of encouragement. And I hear about doctors who don’t do any of that, who seemed rushed, and who get annoyed when patients try to get more information or express an opinion.

But then, I talk to a lot of physicians. I have met some really patient-focused doctors who probably have great relationships with their patients. I have met some who are really up on the latest treatments, who are involved in clinical trials, for example, but who don’t have a lot going on in the personality department. I wonder who they interact with their patients, and if patients don’t walk away out of frustration with his/her demeanor but who might also be walking away from a good specialist. And, to be honest, I have met some really nice doctors who, at the same time, didn’t seem to be staying in touch with the latest data and treatments.

To me, it comes down to knowing what you need from your doctor. Expertise? Information? Sure, but what about emotional support? How much of a personal connection do you need with your doctor if you are going to feel confident in his/her ability to treat you?

And as we often discuss, in today’s managed care environment, bedside manner has to take a back seat behind being efficient and moving on to the next patient. That leaves patients having to gather more information on their own, to be more prepared for their appointments to help the doctor make the best use of time while also getting their needs met, and to find other sources for emotional support as well.

To be honest, I sometimes am concerned when patients talk about how they “love” their doctors. I worry that they may not always be as objective as they need to be about the care they are receiving, and how they will react if the doctor doesn’t meet their expectations for emotional support, or if they are somehow placed in the position of having to change to a new doctor due to managed care requirements or a move, or the decide they need someone with different expertise, or a specialist.

I know that when you are facing a chronic condition, that patient-doctor relationship is really important. But I also remind my clients that your doctor is a medical professional and not your best friend. Patients and doctors still need to be able to be direct with each other, and to ask hard questions, and expect straightforward answers. For example, I have talked with patients who needed to see a specialist but were so attached to their current doctor that they were hesitant to form a new relationship, or to otherwise “hurt” their doctor’s feelings.

I am interested in knowing your thoughts and experiences with doctors and their bedside manner.

Where does bedside manner fit in for you in terms of how you relate to your doctor?

How do you define it? What do you look for?

How much lack of bedside manner – however you define it – are you willing to put up with before you move on? What are the trade-offs?

I often ask clients to answer these questions. Sometimes they decide that the bedside manner is so lacking that they are ready to find a new doctor. Others decide that the doctor is so smart and skilled that they are willing to put up with some abruptness.

Where do you weigh in on this? Any stories? Advice?


40 replies

MoeGig
MoeGig 2011-07-22 22:47:21 -0500 Report

I think bedside manner is, at best, a "nice to have". The most important characteristic that a doctor has is to specifically, (and forcefully if necessary) communicate the dangers of a diabetes if the patient refuses to track their A1C and understand the importance of doing that. As a relatively healthy Type 1 for 46 years, I have learned that you really have to be your own doctor; and if you refuse to accept the disease and fight the life style adjustment necessary to keep that A1C in the 6's, you are in trouble. In this case, the doctor has a responsibility (I believe) to aggressively communicate these facts to his/her patient. If that fractures the bedside manner, so be it. It's like my uncle years ago who had a tracheotomy but wouldn't quit smoking…placing the cigarette in his tube…to inhale. I say worry less about bedside manner and make sure the patient knows the price of failure. Obviously this is a free country and at that point, the patient can make up his/her own mind…after thoroughly knowing the consequences. (I can see the tomatoes coming in my direction as I write this…:>)

Dr Gary
Dr GaryCA 2011-07-23 12:19:15 -0500 Report

Hey MoeGig,

Thanks a lot for chiming in here. You bring up an important point. Chronic conditions like diabetes require a partnership with the physician, and compliance on the part of the patient is a critical aspect of that relationship. If the patient isn't compliant, the doctor can't do his/her job effectively.

Some doctors are more adept at others than using tough love with their patients. Some doctors have more patience (and maybe more patients) than others. They get tired, they get frustrated, they lose their cool. So what may seem like indifference or lack of sensitivity may also be a doctor who just doesn't know how to drive home the point that self-care is a matter of life and death.

I personally would rather have a doctor go off on me than one who sees what I am doing wrong, or not doing, and doesn't take the time to let me know.

This was great. Thanks a lot!
Gary

VickieF
VickieF 2011-07-22 00:19:00 -0500 Report

I think for me anyway, that I need a Doctor who just listens, I mean Really listens to what I say.Most of the time you try to explain how you feel and halfway through they stop you and They tell you what they Think you feel.If they would let you finish the might be able to get to the bottom of something much faster.Treat the whole person not just the diasease.
Vickie

Dr Gary
Dr GaryCA 2011-07-22 20:53:36 -0500 Report

HI Vickie, this is a complaint that I hear a lot, and I agree that it is a valid one. Doctors aren't always very good listeners. They get caught up getting to a solution and moving on to the next patient, or assume that they know what the patient is going to say, and don't really listen. This is frustrating and can mean that important information isn't conveyed. Another reason why patients have to be their own advocates. Thanks!

Diaschm
Diaschm 2011-07-21 23:50:47 -0500 Report

This has been an interesting topic to discuss. I would hope my doctors really knew their area of expertise as well as take the time to answer my questions. It is difficult when that doesn't happen. To tell you the truth I don't have to love my doctor but I do have to ask questions and have them answered. I think when a doctor doesn't do that , I start to wonder if My Doctor knows the answer. Because it is important that I understand my illnesses inorder to stay well or inorder to not further harm my body. There is a certain reasponcibilty to inform the patient.

Dr Gary
Dr GaryCA 2011-07-22 20:57:06 -0500 Report

HI! Nice to meet you! Just getting complete and understandable answers to questions is a really important aspect of physician-patient communications, I agree. It's not about love, it's about honest answers and being able to trust that the doctor knows whay he/she is talking about. Personally, when I feel that a question is being evaded, I wonder if the doctor is being defensive, and then I wonder why? Hiding something or doesn't know? Either way, that raises a flag.

purple1900
purple1900 2011-06-17 11:47:02 -0500 Report

I have to say I feel very blessed with the doctor I have. I am a Veteran and use the VA health care system. My doctor always makes time to answer any question I have and even yesterday took an hour with me when I was only scheduled for a 30 minute appointment. I am able to call and leave a message for her nurse to call me back and she has called me at home numerous times so that I don't have to go in just for a simple question. She also makes sure all my meds have enough refills so that I won't run out

Dr Gary
Dr GaryCA 2011-06-21 16:24:53 -0500 Report

Hi purple!

This is great to hear. I know that it can be difficult to make a close connection in a large bureaucracy. You are really fortunate to have found such a gem, in a doctor and in a nurse. A real blessing!

But I am also guessing that they enjoy working with you, and that caring for you is also rewarding for them. Healthcare professionals respond to nice people.

Hope you are having a good week, and thanks for checking in!

Gary

Graylin Bee
Graylin Bee 2011-06-13 05:28:48 -0500 Report

The Primary Care Dr I had before I moved last year was a very compasionate. He would ask me how I was whenever we met. It was a small town and I knew alot about most of the Drs, which is common in small towns. For awhile we attended the same church. I groomed his dog. However he didn't seem as up on some of the medical info as I would have liked. Smiles and hugs were not really a good trade off for some problems. He was wonderful when I had a serious dark depression. He offered great emotional support during that time, he would call me almost every day. His referral network wasn't very good. My husband had a bad misdiagnoses from one. His nurse practitioners were barricudas. They were hard to deal with and had a tendency to be dismissive. Sometimes it seemed idiopathic was one of his favorite diagnoses. Some symptoms and problems I later learned had relative easy to learn causes. One problem was even one of his specialties, but somehow never even was considered by him. Major oversight that could have altered my life in many ways.
My new Primary Care Dr. has alot of compassion. He listens well, doesn't make you deal with someone else before you see him. Plus all his referral Drs. have been great. He stays in contact with them. He spoke to each of them before and on the day of my surgeries. He seems to be more active in my overall care than my previous Dr. I feel his medical knowledge is greater. I haven't liked all the answers that were found to why I had problems. I am glad he was able to find answers and the people to help me.
It seems the bedside manner works both ways. I hope mine was good last year.
I probably dealt with over 20 Drs. last year. Most had very good bedside manners. It seemed when I was the sickest with the MRSA and the cellulites, then a cancer scare it was stressful on the Drs. When a Dr. doesn't know f you are going to survive or maybe have your legs amputated it is hard on them. They so want to heal. I could see it in their eyes. For the most part I didn't need emotional support. I just needed to know they were doing their best in fighting the MRSA. They weren't there to hold my hand but to try their best to heal me. As my condition improved they became more relaxed. The main Dr. where I was for about 4 weeks had a wonderful sense of humor. He brightened my day in our few minutes together each morning. The first week he did not show that side of himself.
Same with my main wound care Dr. He was so serious at first. But as I improved his sense of humor came out. He seemed so cold and businesslike the first few times. I know he hated causing me pain, but it had to be done to save my legs. I much preferred seeing him laugh and joke with me as I healed. When my legs showed signs that there was a condition that would cause ulcers to recur he was so disappointed. I could see a dark cloud settle around him. When I went back to thank him after the vein ablation surgery I explained how important it was for me to thank him and show him how great my legs were doing. I asked hm if it was hard on him to not know how his former patients were doing. He said yes.
It seemed as I went back and thanked many of the Drs. last year that was the case. They are often left wondering about how former patients are doing. Since most had last seen me while I was still very sick it was a radical change. It was important for me to go and give a little support back to them. Each seemed so surprised that someone would come back and thank them. After all, all they did was save my life.

Dr Gary
Dr GaryCA 2011-06-21 16:20:41 -0500 Report

Hey Graylin Bee,

Always nice to be in touch. So sorry I didn't get to this sooner. How are you doing? I am honored that you would take the time to write such an in-depth reply.

First of all, MRSA is a very serious condition, I'm sure you know a lot more about this than I do. I am glad you had excellent medical care so that you could get through it. Nothing to play with.

What I most thought about after reading your reply was how physicians most likely have to really protect themselves. They see a lot of sad and scary stuff, and I suspect that they have to work on maintaining objectivity so that they can make the best decisions for the patient, separate from how they feel emotionally about the patient. And they have to protect themselves from being so emotionally overwhelmed that they can't function.

You're doctors seemed to warm up over time, to let themselves become more emotionally involved while maintaining their objectivity. It must be a difficult tightrope.

I also wonder if they don't want to make sure their patients don't get too emotioanlly dependent on them, and ask for help in ways that they can't help. I suspect that they learned that they could trust you, that you were open to a friendly relatiionship but that you were not looking for emotional support. They could trust that you would be comfortable with their professional boundaries. And I suspect that they just liked you a lot! And what's not to like?

Thanks again for checking in on this.

I hope you are having a good week!

Gary

Graylin Bee
Graylin Bee 2011-06-23 10:33:44 -0500 Report

Thanks for the thoughtful and kind response.
I don't know how much I really know about MRSA. It was scarey being so very sick and in so much pain. I wish no one else would ever have so much pain.
The emotional tightrope is a good word picture. That is how I feel as a caregiver with my residents.
This week has been a good one. I hope you are having a good one as well.

Dr Gary
Dr GaryCA 2011-06-23 16:13:58 -0500 Report

Hi! Yes, the tightrope metaphor really works here. I am always glad to be in touch. We are both caregivers, so we have a lot in common. Glad to hear that you have had a good week, mine has been going well, too. Let's hope for a good weekend! We will be in touch soon!

oldbuttercup
oldbuttercup 2011-06-12 17:16:48 -0500 Report

I recently had the good fortune of changing my primary doctor to one with and excellent bedside manner. She doesn't roll her eyes, sigh, or look at me like I am the most stupid man on earth. I am still getting to know her but it is definately appreciation at first visit. Attitude is very important to me. I like leaving a doctors office feeling better psychologically, even if my health is not improving at the moment.

Dr Gary
Dr GaryCA 2011-06-15 21:32:55 -0500 Report

Glad to hear you found some one who shows some compassion. It makes for a much more productive relationship, and I would guess also makes her job a lot more fun. Treating other people with disrespect creates conflict, and that makes everything more difficult. Thanks!

Lymy
Lymy 2011-06-11 11:14:56 -0500 Report

I couldn't of said it better myself. I agree with every word from start to finish. I used to be a nurse (LPN) and so when I read the title of your discussion I was motivated to read on. I have just gone through a change in medical care provider. Not because I had any ill will with my last doctor but because she moved her practice too far away for me to continue to go to see her. For the past 10 years my husband & I would drive 34 miles each way to see her but now she is approximately 55 miles away from our home and that was just too far to go to get medical treatment, and whereas I loved her as a doctor, her nurse needed a good course in patient bed or chairside manners.

Thank you for no truer words.
Regards
~Lymy~

Dr Gary
Dr GaryCA 2011-06-12 14:58:29 -0500 Report

Hi Lymy,

You are most welcome. And thank you for your kind words. I am that as a nurse you have experienced all kinds of communication styles in physicians and patients. Not to mention nurses.

It must have been a difficult undertaking for you to find a new doctor. I hope you have been alble to get connected with one who is able to provide the level of communications that you expect.

Stay in touch! Take care,

Gary

Pam S
Pam S 2011-06-11 08:46:11 -0500 Report

i've seen a lot of docs too. Only had a few with less than desired personality traits. However, utilimately I could really care less. I need a doctor who knows what they are doing and can stay in touch with the reality of this illness we all share. I just want a doc that can answer my questions and lead me down the right path for wellness…

Dr Gary
Dr GaryCA 2011-06-12 14:52:11 -0500 Report

HI Pam,

Thanks for replying. Just being able to ask questions, and get answers -- this is the basis for a productive patient-physician relationship. This is what's most essential. Sounds like you have established that with your doctor. If so, I suspect that he/she appreciates the same level of honest in you.

Take care!

Gary

majikinfl
majikinfl 2011-06-10 13:46:51 -0500 Report

Being a retired RN I have seen Doctors in training and wondered if they would ever have a big practice as their bedside manner was so missing!! I have also seen the opposite where they were wonderful but dumb as homemade soap. Doubtful they ever had or would read a journal article. As for my own Doctor I would trade "warm fuzzies" for knowledge IF he had the ability to tell me information in a manner understandable to me. Yes I am an intelligent medical professional, however when I go see the doctor I want plain english not 100 words I have to go home and look up. On some level I may understand him/her but at that moment I am a patient scared, confused or lacking in knowledge. I want, infact demand they tell me the whole truth not some candy coated story they think I need to here…just the facts about the disease I have, the treatments available, prognosis and what HE/SHE plans to do for me. He/she must give me all the lab results not pick and chose what they tell me. Bedside manner to me is how the Doctor carries themselves, clear spoken English, look me in the eye, shake my hand…and do a physical exam the first time he/she sees me and not rely on my words or the words of previous care givers. I see to many unwilling to answer questions often considering it a challenge to their supremacy as "the Doctor". So that would be another part of bedside manner. I am not looking for a parent just an intelligent, kind, caring person who at least acts like I matter to him/her as a patient and not just $$$ in their pocket. I seen old country doctors and city doctors with a hall and office full if diplomas and awards…neither of which had a clue…and then the opposite…so awards, degrees and commendations do not make a "real good" doctor. I don't expect hugs, cards on my birthday or phone calls to see how I am doing…nice it might be NO doctor has the time to see patients 1 every 10 min for 8 hours, educate themselves beyond their degrees, and research each patients history in depth and make personal calls…JUST NOT realistic. I appreciate how much work is involved in being a good Physician…just please take time to call me by the correct name, evaluate the correct diagnoses and give me the bottom line…referrals if you are not sure…allow me to say no thanks without recriminations. Don't force feed me, and don't get mad at me when I disagree. I appreciate your article. I also look forward to the comments from other members of DC.

Dr Gary
Dr GaryCA 2011-06-10 16:35:48 -0500 Report

Hi!

This is fantastic, thanks a lot. There is a lot to be said for the plain, honest truth, willingness to listen and to answer questions in plain English. I have also met some doctors who seemed like incredibly nice people but that I could tell weren't keeping up with the latest knowledge and might not be the most competent.

We have to have realistic expectations of our doctors, including recognizing that they are working under managed care constraints. Warm fuzzies take time that isn't available these days. Honesty, eye contact, competence -- being focused during those 10 minutes -- are the key elements in the relationship, and the basic essentials.

Thanks again! Totally appreciated!

I will be interested to hear how other members weigh in.

Gary

2011-06-10 13:14:02 -0500 Report

Hey Jeffrey~~ Now w/my Endo, I had him for 8yrs. At the beginning he was cordial enough, then he turned into a pompous (being nice) jerk. I dropped him like a hot potato. Since he's the head of the dept. I refuse to set foot into the Endo area. However, my PCP is a great guy, great MD and even though he didn't "major" in it in med school, he happens to know more about diabetes, then my old Endo (who "majored" in it.) school. Again, like you, I wouldn't go out & have dinner w/him but he's a really great dr. (P.S. Although, I did see him one or twice @ my old gym.)

Dr Gary
Dr GaryCA 2011-06-10 16:24:11 -0500 Report

Experience plays a big role here, doesn't it? If you have a PCP who has a lot of expereince, and keeps up with the latest developments, and you have a good relationship, then that is worth a lot.

2011-06-10 19:26:26 -0500 Report

You're right Dr. Gary. I do have a good relationship w/him. But I'll be really bummed when he retires at the end of the year.

Dr Gary
Dr GaryCA 2011-06-12 14:38:12 -0500 Report

It is always hard to lose a doctor that you really like. I hope yours is transitioning his practice to someone that you will like, or that he makes a recommendation.

2011-06-12 15:02:59 -0500 Report

No he's hanging up his stethoscope for good. He's been practicing for years. Now he wants to go practice something else. His golf (or tennis) swing!! (No I found a nice young one who's also very knowledgeable in diabetes. He's a youngin'. Been practicing for almost 7 years. So, I think that should hold me for a while. (I hope).

Dr Gary
Dr GaryCA 2011-06-12 15:44:12 -0500 Report

Great! Glad you have connected with a doctor that you like. I am in my late 50's and am at the point where I like my healthcare providers to be younger than I am. That way, chances are they will be around as long as I need them. Is that being realistic or cynical? Maybe a little of both.

jeffrey9127
jeffrey9127 2011-06-10 13:20:14 -0500 Report

It is always good to have a PCP that gives his patients the best care, and is not as you say a jerk. I would say we are both fortunate to have such good Drs.

2011-06-10 19:43:50 -0500 Report

You're absolutely right Jeffrey. We are both very fortunate to have good PCPs. I had my PCP for 18 years. But like what I told Dr. Gary, I will totally be bummed when my PCP hangs up his stethoscope at the end of the year. It'll really be hard finding a new one, that I will like.

jeffrey9127
jeffrey9127 2011-06-10 12:45:57 -0500 Report

I have had the same Dr. for about 15 years. He is very good, and has always been straight forward with me. When I have needed specialized care, he has taken the lead and made the arrangements. I treat him with respect, and he treats me with respect. We have had differences of opinions, but he is the Dr., I am not.

But, with that said, we are friendly toward each other, but not friends. And I like it that way. He provides a service, which helps me stay well. I don't believe that I should expect anything more from him.

Dr Gary
Dr GaryCA 2011-06-10 13:07:27 -0500 Report

Hey Jeffrey!

Great to hear from you. Sounds like your doctor is a real find. And I especially like what you said about being friendly but not friends. Knowing the limits of your relationship helps both of you to stay objective.

Hope you are doing well!

Gary

Gabby
GabbyPA 2011-06-10 09:30:17 -0500 Report

My first doctor visit was horrible and I would say the NP's bedside manner was pretty bad. I was getting my first official diagnosis and she just made me feel like an idiot and crummy. She wouldn't answer my questions and treated me like I should have never gotten diabetes. I had not cried about having diabetes until I met her and I had been dealing with it for over 9 months on my own. Needless to say, I never saw her again.

Now I have a doctor that talks pretty straight to me. I may not always like what he says and I have to admit, we do have disagreements. But we work them out and I have to say that his manner is much better. It is still not "friendly" like I would invite him to my cook out, but we get along well and we know that we both will speak the truth about what is going on. That is what makes me very happy when he is happy with my visit, and makes me upset with myself, when the visit is not so great. I know it is my responsibility to keep my life in control. I ask his advice and he offers some. I get most of my best advice from here, but it is good to get confirmation from him on certain things.

Good bedside manner to me is important. That doesn't mean they will always be sharing flowers and rainbows. A good doctor will speak the truth with compassion and not leave you in shock. I feel my doctor has a good balance and so far, what we have grown into is working for both of us. We have worked hard to get there. I feel we are both happy with how our relationship is.

2011-06-10 20:01:56 -0500 Report

Hey Gabby, When I first got connected w/ my PCP (18 yrs ago.), he & I rubbed each other the wrong way, but after a short while he & 1 grew on each other. And after being his patient for about 3 years, is when he diagnosed me w/type 2.

Dr Gary
Dr GaryCA 2011-06-10 10:51:55 -0500 Report

Hi Gabby!

Great to hear from you. How you doing?

I really like what you said here. It sounds like you started out with the best worst example of how healthcare professioanls at their interpersonal worst can have such a negative effect on patients.

You comment about flowers and rainbows is well said. Patients need a certainly level of tough love from their healthcare providers, concern with straight talk. To me, one of the most important aspects of bedside manner is a willingness to listen, even when the patients is disagreeing with a recommendation, and not so defensive that he/she can't listen to the patient's concerns.

Honesty with compassion!

Thanks a lot.

Gary

Gabby
GabbyPA 2011-06-11 08:43:06 -0500 Report

I am doing pretty well, thanks Gary!

That was the part that struck me in that our doctors really do have to find a way to show that tough love. It takes humility on our part as well to know that when they share those harder to hear words, that we need to really pay attention and not take it as a personal attack, but as an urging to improve our health. We have to not be so sensitive and get hurt feelings. We have to grow up and realize that we are dealing with a life threatening disease and take it seriously. Sometimes, we do need a kick in the butt, but it is nice if they are wearing slippers instead of steel toe boots. LOL

Dr Gary
Dr GaryCA 2011-06-17 11:23:37 -0500 Report

Slippers and not steel toe boots! That one is priceless!

The tough love seems to be a key. As patients, it is human nature to want to be treated with compassion and empathy, to feel like the healthcare professional really gets what we are going through. But compassion also includes honesty, presenting the facts and honoring the patient's ability to make decisions, to act as a responsible adult, to be empowered. And I think doctors have to sometimes drive home the fact that they can't do it all, and neither can the meds.

Honesty and humility, you're right.

Have a great weekend!