Recapturing Meaning in Medicine

"I have never seen a doctor more dedicated and show such compassion for her patients."
—A CCU nurse comments on her physician’s care at Advocate Good Samaritan Hospital.

While reading Dr. Stephen Beeson’s book, "Practicing Excellence: A Physician’s Manual to Exceptional Health Care," I realized that one essential question must be answered before we can effectively focus on new strategies for improving care: What do physicians really want out of our careers and lives?
The simple truth is that we want to fulfill our common, compelling purpose of making a real difference in our patients’ lives. To heal and care for them and when recovery is not possible, provide the best care available while relieving their suffering. If they are destined to die, we want to ease their passing, comforting their loved ones with the assurance that everything that could have been done, was done.
The personal benefit of providing such care reaches beyond fulfilling our obligation as healers and extends deeper into our human need for happiness. Evidence for this can be found in a book titled, "The How of Happiness: A Scientific Approach to Getting the Life You Want," where Sonja Lyubomirsky compares happiness to a pie. Research shows that 50 percent of the pie is determined by the inherent happiness tendencies we were born with, for better or worse, which is the level we naturally gravitate toward. Surprisingly, only 10 percent of happiness is determined by our circumstances such as how much money, fame and fortune we have. As the old story of the lottery winner goes, after the initial thrill, the winner will eventually adapt to the situation and go back to their happiness baseline. The remaining 40 percent of the pie is ultimately the most critical part of our happiness and is dependent on our intentional actions, things we actually do in our daily lives.
When we apply these facts to patient care, it is clear that how we interact with and satisfy our patients through our intentional actions will directly affect how happy our practices and lives will be.
The main case, therefore, for cultivating behaviors that increase patient satisfaction is the fulfillment and happiness they facilitate for physicians. Some added bonuses are increased patient compliance, decreased malpractice lawsuits and business promotion, since word of mouth is still the No. one source of new patient referrals.
I thought I knew everything about bedside manner and perhaps I did know a lot. But I found that there were some simple practices highlighted in Dr. Beeson’s book that could be implemented to enhance patient satisfaction. If these are done on a consistent basis, with every patient encounter, I found that they really do make a difference.
The following steps are easy and I encourage everyone who deals with patients to try them:
Knock—announce yourself before entering

Acknowledge and greet patients with a smile, handshake or touch on the shoulder
Introduce yourself—for established patients connect with questions about family or work
Sit at the beside or in a chair at or below eye level to make good contact
Always let patients speak first without interruption
Take history and perform exam—explain steps and ask encouraging questions
Explain workup and treatment thoroughly using common language—ask patients to paraphrase information
Elicit questions that have not been answered and anything else you can do
Thank patients—end with another hand shake or touch on the shoulder

At first I was nervous about eliciting further questions from patients. Overcoming this fear, I began asking. I found there were three ways in which patients responded. Surprisingly, the vast majority of patients told me there was nothing else they needed. This assured me that I had done a pretty thorough job of explaining. The next was with additional questions, which were usually simple and easily addressed. The final way was the rare occasion when a crucial issue surfaced. For example, a patient visiting for high cholesterol and blood pressure, when asked about additional questions, abruptly said, "If you really want to know why my blood pressure is up, it’s because I’ve been having rectal bleeding." Such revelations could be central to averting colon cancer or providing an early diagnosis and could have been missed without this final question.
Saying "Thank you," to patients, was initially a mystery to me. I thought, why should I say thank you to a patient? The reason is now clear. "Thank you" is an expression of gratitude, for their support, presence and cooperation. In addition, showing gratitude is one of the most powerful intentional actions we can take to improve that 40 percent of their happiness.
The beauty of including these simple practices is in the results they create. Beginning and ending visits focusing on the patient facilitates their empowerment and greater sense of satisfaction. This translates into a more gratifying physician experience and, believe it or not, fewer phone calls.

Further details can be found in Dr. Beeson’s book, "Practicing Excellence: A Physician’s Manual to Exceptional Health Care." To obtain your copy visit http://www.studergroup.com/.