Medical: Docs' manners can affect patient outcomes

Originally published Monday, November 7, 2011 at 7:03 PM

Study shows patients notice whether their doctor seemed in a rush, made eye contact and listened carefully to what they said.

By LEE BOWMAN
Scripps Howard News Service

In today's harried medical environment, what doctors and other medical professionals say or don't say to patients may matter more than ever.

Congeniality is no substitute for competence, of course, but most patients prefer that their doctor treat them with respect and concern.

So there's little surprise about patient views in a recent study done by the University of Michigan Health System that videotaped 18 doctors' interactions with 36 patients, and then interviewed both participants afterward.

Overwhelmingly, the patients focused on whether the doc seemed in a rush, made eye contact and listened carefully to what they said.

On the other hand, doctors had more diverse views about their interactions. Many expect that patients may not be entirely forthcoming and look for clues that they're holding back information, or that they're depressed, from tone of voice and eye contact. For clues, they compare how the patient looked the last time they were in to the present visit.

But a subset of the docs — about a third — also were highly aware of the signals they were sending in their own body language and tone. "I use my body a lot,"one doctor commented while analyzing a tape. "It's nice to see that I don't look rushed in the room, although in my mind, I'm whirling."

Dr. Stephen Henry, the project's lead author, said the study was intended mainly to explore just what sorts of visual and verbal cues are exchanged in exam rooms, and to lay the groundwork for more studies that might help establish standards or guidelines for the interactions, or at least make doctors more aware of what they're doing to diagnose and treat patients.

A recent Duke University study of oncologists used a computerized tutorial that gave quick feedback on audio recordings during their visits with patients.

Half the 48 doctors in the study also completed the tutorial after the entire study group attended a lecture on communication skills. Then all the doctors had another set of patient encounters evaluated.

Oncologists who had not taken the tutorial made no improvement in the way they responded to patients when confronted with concerns or fears. Doctors in the trained group, however, responded empathically twice as often as those who received no training. In addition, they were better at eliciting patient concerns, using tactics to promote conversations rather than shut them down.

"Patient trust in physicians increased significantly," said Dr. James Tulsky, director of the Duke Center for Palliative Care and lead author of the study. He added that patients feel better when they believe their doctors are "on their side."

Of course, if your doctor is not merely clinically cool, but actually has a prickly, boorish personality, it might be a real danger sign for your care.

Dr. Andrew Klein, a transplant surgeon at Cedars Sinai in Los Angeles, and Pier Forni, founder of the Civility Project at Johns Hopkins University, recently analyzed prior studies on surgeons' behavior in the operating room and their patients' outcomes.

They found that patients of doctors who were courteous in the operating room were more likely to survive and avoid postoperative complications than those treated by doctors who bullied or talked down to staff. Other research suggests that this phenomenon extends to hospital wards: Patients are less likely to suffer from errors if nurses and other staff are comfortable raising questions about a doctor's orders.

Then there's the sticky question of medical humor. Does your doctor tell you jokes, or does he tell colleagues jokes about patients?

The truth is, he or she probably does both. And that's OK. Humor is a good way for doctors and patients to bond and relieve tension.

But the often-dark humor of the medical workplace is a bigger ethical minefield.

A number of blogs and websites have cropped up to share OR and ER humor with colleagues and the public.

Katie Watson, an assistant professor of medical humanities and bioethics at Northwestern University, wrote a recent essay addressing gallows humor in medicine.

Her case study: A delivery boy bringing a pizza to a group of resident physicians is shot and robbed just outside the hospital. The emergency room residents struggle unsuccessfully to save the teen's life. Afterward, one of the doctors finds the pizza on the sidewalk and brings it inside. Another resident wonders: "How much do you think we should tip him?" Everyone laughs and they eat the pizza.

Watson's call is that there's nothing wrong with the joke. It may have allowed the residents to "integrate this terrible event and get through the shift." The residents needed to deal with the trauma in some way before they could eat, and they needed to eat to be at their best for the next patients they saw.

She argued that the notion of docs needing to cope and relieve their stress doesn't excuse cruelty or bullying. But, she added, "To me, the butt of the doctor's tip joke is not the patient. It's death."