During a recent and troubling discussion with a physician friend, he described to me a new ailment he’s been experiencing: waking up in the morning, and not looking forward to going to work. The reality is that he is not alone. It’s no secret that physicians across the country, regardless of their specialty or location, are reaching their limit for juggling new requirements, technology upgrades, and policy changes, all while trying to deliver personalized, quality care to their patients. As a result, busy physicians are, quite understandably feeling pressured and pulled away from direct patient care and critical clinical-decision making, and, at the end of the day, that is what matters most to patients and physicians alike.
It is easy to imagine the impact overloaded and dissatisfied physicians could have on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores, and how these regulatory pressures and so many new healthcare technologies could be linked to the decline of the “art of medicine.” But are we, in fact, misdiagnosing the problem?
A recent study from Johns Hopkins University found that internal medicine interns are lacking proper bedside etiquette, which is not only essential to providing quality care, it directly impacts medical outcomes and patient satisfaction scores. Focusing on five key elements of proper patient-physician decorum, researchers tracked whether or not hospital interns:
- Introduced themselves,
- Explained their role in the patient’s care,
- Touched the patient,
- Asked open-ended questions, or
- Sat down with the patient during the visit.
Results revealed that interns touched their patients (either during a physical exam, handshake or gentle, supportive touch) 65 percent of the time and asked open-ended questions 75 percent of the time, but introduced themselves only 40 percent of the time, explained their role merely 37 percent of the time, and actually sat down during only nine percent of the visits. Such results are disconcerting, at best, and reveal a more pressing truth: These basic and critical communication deficiencies that are essential to providing holistic patient care are not being taught.
The study exposes the reality that the shift away from patient focus and the “art of medicine” isn’t just stemming from increased physician workloads caused by new policies and changing technologies. It is infiltrating our profession through a change in training, as well. While we have reduced junior doctors’ work hours for safety reasons, we have not adjusted the overall length of training they receive. Medical students, our future physicians, are not receiving the holistic education that helps them balance keen scientific skills with compassionate delivery.
But, as they say, “knowledge is power,” and now that we are starting to pinpoint conditions that are tearing at our profession, we can start to heal them. We can’t expect our medical interns to know how to handle difficult and emotional situations unless we show them. We need to teach them how to engage with patients, earn their trust, really listen and understand them. They need to be able to view what their patients say through both a lens of science and medicine, as well as a lens of compassion and caring, in order to help them get and stay well.
And what of the technology challenges that are driving wedges between patients and physicians? While there is no denying that much of health information technology is putting pressure on physicians and forcing them to adapt to new methodologies, these challenges are a necessary to revolutionizing patient care. They are, in essence, the basis of growth and the very nature of science. If it weren’t for boldly trying new approaches, we might still be relying on leeches and blood-letting to cure melancholia. Just as we can’t expect a patient with heart disease to know intrinsically to maintain a low-sodium diet, we can’t expect the healthcare industry to know how to fix everything unless we speak up and advocate for change (especially with the other loud voices of insurers and politicians speaking on “our behalf”).
We must be mindful that as physicians, it is our sworn duty to defend the practice of delivering the best care to our patients from anything that threatens to impinge on that quality. We need to stay engaged and be responsive; and that also means we need to assist with diagnosing major technology pain points and identify when something isn’t working. We have the rare opportunity to shape the future of healthcare infused with technology and I, for one, want to be part of developing a solution that helps the next generation of physicians offer that comforting touch as they deliver an even greater level of care to their patients.
Dr. Nick van Terheyden is the CMIO at Nuance Communications where his insider perspective allows him to put his medical and technology expertise to work for clients who are striving to raise the bar for healthcare delivery paying attention not just to processes and systems, but to people. His ability to speak in terms people can actually understand makes him a sought out speaker on the practical and futuristic use of technology as a necessary adjunct in quality patient care. Follow him on Twitter.
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