"Doctors who score poorly on communication more likely to generate complaints"
Doctors who score poorly in the communication portion of a skills examination they take before becoming licensed are more likely to be the subjects of complaints to regulatory authorities later when they're practising physicians, says a new Canadian study.
Good evening, class. Today's lecture is entitled "How to Develop A Winning Bedside Manner." I see that the room is filling up - could some of you in the back please move up front? C'mon, don't stand back there like a bunch of f***ing morons - get down here and find a seat!
Now, the first thing you must do when entering a patient's room is to establish eye contact. No one feels inspired meeting a doctor who looks like he's being frog-marched out of the county courthouse. I don't care if your girlfriend just called you to say she's dumping you, you have to put on a happy face. I don't care if you look like the spitting image of Charles Manson, like this tough guy in the front row here - you have to establish a strong presence in the room. This gives you the power - capisce?
The standardized exam is given across Canada, with test-takers seeing 20 or so cases of people posing as patients with a range of problems. The physicians are assessed on their performance, including communication skills when discussing difficult situations with patients - for instance, treatments for potentially deadly illnesses. On the communication section of the exams, the scores ranged from 31 to 723.
Someone with a score of 31 would probably have been rude to the patients repeatedly, "interrupting them, being rough, being insulting," [study author Robyn] Tamblyn explained from Montreal.
Yes, question?
"I was wondering how to tell a patient that they have a disease like cancer or-"
I'm getting to that, okay, Sweetheart? I'm getting to that, geez, let me talk, okay? Now, when you talk about a patient's disease try to use some empathy, if you understand what that is. Put yourself in their shoes, no matter how smelly they may be, ha ha. Also, if you have a chance, be vague when talking about the future. People who are told bad news like to kill the messenger, if you know what I mean. If you can't get out of it you can tell them how long they have left to live, but don't expect to be invited out to dinner.
Complaints to regulatory bodies were studied through to 2005, and it was found that 17 per cent of the physicians in the study had at least one retained complaint filed against them. (Others had complaints that were discarded.) Of those, about 80 per cent were for communication problems - such as rude or abusive language - or quality of care problems, Tamblyn said.
Yes, you in the back? Whaddya want?
"How can we encourage a patient to fight on when things aren't going-"
Who the hell told you that? That's a crock of shit. "Fight on" - what are you, a cheerleader? Listen, your job is to tell the patient what the deal is, okay? Leave the inspirational speeches to the Padre. Fuggitaboudit, this namby-pamby stuff.
Communication problems and inappropriate treatment/follow-up were the most common causes of quality-of-care complaints. Examples of communication that would receive a low score include doctors who show condescending, offensive, or judgmental behaviours, or those who ignore patient responses during office visits.
Physicians who scored in the lowest 25 per cent of those tested in the clinical skills examination were most likely to generate complaints, adding up to 170 complaints above what would be expected statistically annually.
"Low scores on the exam were quite predictive. The higher your score, the less likely you would get complaints," said Tamblyn.
I know you geniuses are going to do your assigned reading tonight, because we're having a test tomorrow on the first six chapters. Looks like some of you might miss the big game after all, ha! If you forget everything you've learned at least try to remember this: the patient expects you to have all the answers, so when at the bedside, if you don't know the answer, for Chrissakes, don't admit it - make something up!
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If you forget everything you've learned at least try to remember this: the patient expects you to have all the answers, so when at the bedside, if you don't know the answer, for Chrissakes, don't admit it - make something up!
I went through several PCPs before settling on the doctor I've been seeing now for nearly 20 years. He won me as a permanent patient when I experienced a minor but very annoying side-effect of a anti-inflammatory drug he prescribed. His response was, "I never heard of it doing that before. Let me look it up." He came back three minutes later with "Wow, that is a recorded side-effect in a small number of patients. Here. let's change to another medication."
A doc who clearly was willing to admit that he didn't know everything was a breath of fresh air, compared to my previous PCPs.
Another hysterical entry! But soooo right on the money. This is exactly the message I try to communicate to every resident and fellow I work with -- the importance of communication, and how if you're a good communicator, and if you are willing to admit when you don't know something and offer to look up the answer (and actually FOLLOW THROUGH), your relationships with your patients (and their families) will be strong, and that's sometimes the most important thing we can offer to them.
Another hysterical entry! But soooo right on the money. This is exactly the message I try to communicate to every resident and fellow I work with -- the importance of