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Doctors' Bedside Manners Put to the Test - 2003-02-17


American doctors pay a high price to practice medicine, some say, too high. The escalating cost of protecting themselves from lawsuits is prompting some doctors to stop offering care for certain high-risk conditions, and driving others from the profession entirely. But several studies published over the last decade in prominent medical journals indicate there's a simple way to cut the number lawsuits: improve one's "bedside manner."

Doctors who have a good rapport with their patients are less likely to be sued for medical malpractice - and that's an observation all three of West Virginia's medical schools are taking very seriously.

Jeff Sinclair, a fourth-year medical student at Marshall University in Huntington, wants to be an eye surgeon. To reach that dream, he's taken the usual classes in gross anatomy and behavioral medicine, but he's also taken something else - a test of his bedside manner.

The bedside manner test, officially known as the Clinical Competency Exam, is given at all three of the state's medical schools at the end of the students' third year. The patients are actually actors trained to portray various illnesses.

Sarah McCarty, Associate Dean of Academic Affairs at Marshall University says one difference between this and a real exam is that the student is evaluated by both the instructor and the 'patient'.

"What we're looking for is their interaction with the patient," she said. "Do they treat the patients with respect? Do they speak in language the patients understand, or do they use medical terms the patient can't understand?" That may sound like a small detail, but Angie Dawson, who's played a patient for the last five years, says sometimes medical students use a lot of jargon, which she counts against them in her evaluation.

"I was always honest in my evaluations because I feel it helps them become better doctors," she said.

A poor review on the test is serious because passing the clinical competency exam is a requirement for graduation. Students who fail, must spend extra time in patient clinics, working on their bedside manner before they're allowed to retake the test.

Fourth year medical student Laura Feaster says even though the test is staged, there's a lot to be learned from it.

"You spend your entire third year seeing patients over and over again," she said. "You kind of get into a system and a way of interacting with patients. I don't think it's something you can fake at the last moment."

But if a good bedside manner is something that can't be faked, why test it? Dr. McCarty says the answer is simple: like any other subject, communication skills can be learned, and like drawing blood, or diagnosing illnesses, medical students must show they've mastered the art of talking to patients.

"I think for some time we did take the attitude that they did know [how to talk to patients]," she said. "The more we look at the world of medicine, we see there are problems. We think it is our job as medical educators to be sure that our students can do this. I don't think we can just assume that they can do this."

With that thought in mind, proper bedside manner is emphasized from the day students arrive. Marshall's Director of Educational Development, Marie Veitia, says when they receive their white lab coats, they're reminded of the responsibilities that go with wearing them. "We all know how to form good relationships as just regular human beings but we don't necessarily always take the time to break down what the components are such as empathy, respect and genuineness, being real with your patients," she said.

While textbook examples are helpful, ophthalmology student Jeff Sinclair says he's learned most of his bedside manner on the job.

"We interact with a lot of attending physicians and it's good to see all the different styles and pick and choose how you want to act," he said. "It's good to see both good bedside manner and bad bedside manner so we can pick up and know the difference and turn ourselves into the doctor we want to be."

While empathy and respect may go a long way toward avoiding a malpractice court battle, Marie Veitia says a good bedside manner may have another more significant benefit.

There's literature to indicate that patients that have good relationships with their doctors are more likely to follow the doctor's recommendations and do what the doctor says," Ms. Veitia said. "So therefore they would be more likely to get better more quickly by following the recommendations."

Neither Laura Feaster nor Jeff Sinclair is really worried about medical malpractice yet. Both have years of school ahead of them before they are ready to practice, and they hope the state's medical malpractice issue will be a distant memory by then.

"Doctors are human. Good doctors make mistakes as well as bad doctors," Ms. Feaster said. "I think if you have a good working relationship with your patient and are honest and up front with them, that they are more willing to accept that you're a human being just as much as they're a human being."

While Miss Feaster and Mr. Sinclair have passed Marshall's bedside manner test, they may have to take another before hanging up their shingle. The West Virginia Medical Licensing Board is considering adding a clinical skills exam to its physician certification process.

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