GPs work in busy and demanding environments, but while balancing your many tasks and responsibilities it is important not to forget about the basics.
These include your demeanour or manner as a doctor: the way you behave as perceived by your patients. Do you come across as harassed, intimidating, impatient or distant? Or do you try, however pressured you are feeling, to listen carefully to patients and try to ensure they understand what you say to them?
Here is a cautionary tale:
Computer first, patient second
Mrs A brought her 13-year-old son Mark to see Dr H. The adolescent had a two-day history of pyrexia and a sore throat, and was finding it painful to eat and drink.
Dr H entered details on his computer screen while Mark was describing his symptoms. After performing a brief examination of Mark’s throat, Dr H diagnosed a viral infection, offered brief advice and continued to enter details on his computer as Mrs A and Mark left the consulting room.
Two days later Mark attended the local out-of-hours centre as he could no longer swallow fluids and was in increasing pain. He was diagnosed with acute bacterial tonsillitis and admitted for IV fluid replacement and antibiotics. Mark made a full recovery.
Safety-net advice not given
But 10 days later Dr H received a letter of complaint from Mrs A, who was unhappy with Dr H’s bedside manner.
While she appreciated that Mark was likely to have had a viral sore throat at the time, she criticised Dr H’s attitude and his failure to provide an explanation or ‘safety-net' advice.
Unfortunately this scenario is not unusual. Poor bedside manner can be a major contributing factor in patient complaints and can also lead to adverse clinical outcomes.
Top risk is communication failure
Data collected from more than 150 clinical risk self assessments (CRSAs) conducted in general practices by MPS in 2011 identified communication as the top risk. Many complaints and claims may not be brought if there is a good doctor/patient relationship.
There are many challenges to maintaining a good bedside manner, including time pressures, QOF targets and personal stress.
While good communication and empathy are second nature to some GPs, others might find it useful to improve their skills by attending a communication workshop or receiving training. A good bedside manner helps to build a patient’s trust and satisfaction and so improves compliance and clinical outcome.
Revalidation is set to start at the end of 2012 and GPs will be expected to submit feedback from colleagues and patients. The GMC has designed a patient feedback form that some refer to as the ‘GP politeness survey’ and you will be encouraged to reflect on their practice, with a heavy emphasis on interpersonal communication.
10 top tips to improve your bedside manner
1 Greet your patient politely.
2 Maintain good eye contact.
3 Keep your posture open.
4 Allow the patient to talk without interruption.
5 Respond to any cues.
6 Explain the purpose and process of any clinical examination before undertaking it.
7 Offer a chaperone for intimate examinations.
8 Take the time to explain the diagnosis to the patient.
9 Involve the patient in treatment management decisions.
10 Show the patient respect and consider walking with them to the consulting room door when the consultation is over.
- Dr Birch is a medico-legal consultant at the Medical Protection Society (MPS)