By SANJAY SAINT and MOLLY HARROD
A good relationship between a patient and his or her physician is the cornerstone of superb medical care. That relationship is important when you know the doctor well. It may be even more important when you don’t, say when you are in the hospital.
Growing competition for new customers is inspiring American hospitals to focus on providing a more positive patient experience — and hospitals expect their doctors to do their part.
We wanted to know what defines great physicians in the hospital setting (sometimes called attending physicians), both in terms of their interactions with patients and how they teach the next generation of doctors — residents and medical students — as they go about their hospital rounds.
To do this, we identified 12 doctors from around the US who are recognized as outstanding teacher-physicians. We scrutinized their bedside behavior, did semi-structured interviews with them, and talked with current and former members of their hospital rounding teams.
What we learned, in a nutshell, is that the way these doctors work is uniformly at odds with the familiar perception of the hospital physician as rushed and impersonal.
Based on our research, we have drawn up a checklist of items reflecting how these top doctors interact with their patients. It might come in handy if you or a loved one must spend some time in a hospital. One caveat: You may be cared for by a team of hospital physicians, some of whom are in training. We compiled the checklist with the most experienced physician in mind; he or she supervises the team. That said, all team members should ideally display these behaviors.
Preparation. She has studied your medical records and is familiar with the latest lab tests and other diagnostic results.
Arrival. He enters your room smiling, introduces himself to you, and shakes your hand. He establishes a personal connection with you through brief, informal conversation.
Hand hygiene. She washes her hands before touching you.
Physical exam. He closes the hospital door or closes the curtain to preserve your privacy. He warms the stethoscope before applying it directly to your skin — not to your hospital gown. He explains his actions, and works to make sure you feel you are being treated gently.
Communication. She speaks with you while sitting on a stool or kneeling in order to communicate at your eye level. She asks how you are feeling, explains medical issues clearly and in layman’s language, and tries to make sure you and, if appropriate, your family member understands. She makes sure that you agree with the medical treatments that have been proposed and asks how you feel about these recommendations. She encourages you to ask questons.
Departure. He recaps the plan for the day, bids you a pleasant goodbye, and leaves your room as he found it — bedrails, lights, and TV volume adjusted to the way they were before the visit.
Anticipatory planning. She prepares for your leaving the hospital by making sure you have transportation and appropriate medical follow-up, as well as the help you need at home to ensure that you continue to improve.
Collaboration. He treats all members of the hospital team — nurses, social workers, pharmacists, residents, and medical students — with kindness and respect. In short, he plays well with others.
The 12 remarkable doctors we observed had their individual differences, of course. Some spent more time joking with patients than others. A few encouraged the students or residents in the group to speak up more. There were variations in the way they did physical exams and how much time they spent with each patient. But they shared a desire to partner with their patients and to treat them with reverence and compassion — treatment all patients should receive. And they did the same with their colleagues.
If you find yourself in the hospital, use this checklist to see how your doctors measure up. If they fall short in some regard, call them on it — politely, we hope. But if they pass, a resounding “thank you” would be appreciated.
Sanjay Saint, MD, is the chief of medicine at the VA Ann Arbor Healthcare System and professor of internal medicine at the University of Michigan. Molly Harrod, PhD, is a medical anthropologist at the VA Ann Arbor Healthcare System. They are coauthors of “Teaching Inpatient Medicine: What Every Physician Needs to Know” (Oxford University Press, March 2017). This article reflects the personal views of the authors and not necessarily those of the University of Michigan or the Department of Veterans Affairs.