Carl Gandola's bedside.org is active again .. so I guess he's been on service this month. Too bad we can't get his colleagues (or his residents) to keep the fire burning when he's not on service!
"By osmosis and by repetition over this month we have all learned to communicate better about patients, to listen to their concerns (and think about sitting down in a chair at their bedside). We have developed management plans to improve individuals' health and relieve their pain. We have all worked hard, grown tired at times, learned, and been part of a team giving good care."
It's the beginning of the year for our 4th year medical students, and I am reminded again about the defferences between how we train physicians in residency They struggle with career choices, and I struggle with how best to guide them. Innately, Carl guides his learners to listen to their patients — and to literally get down on their level by taking a seat at the bedside rather than maintain the physical dominance of standing above them. If you were a patient in a hospital bed, would you prefer …
standing:
or sitting?
Which patient feels more empowered and involved in their care?
… and it's interesting to me that an educator in family medicine involves this in both his education, and in his discussions of education as an important part of healthcare … while educators in other specialties just don't address these issues so routienly. While our residents often refer to Behavioral Science sessions as "BS" … this remains a required component in the training of family physicians (and no other specialty aside from psychiatry, of course), and an important differentiator in how physicians are trained. There is also evidence to support the hypothesis that this difference in training also may have impact on the healthcare that these physicians provide.
This is right on. Family doctors “get it” in a way that internists and OB/GYNS just don’t. By seeing the whole patient instead of seeing the patient as a vessel for diease (or pregnancy), the other “primary care” specialties miss the boat big time. Yeh yeh sure, there are good doctors who are not family doctors, don’t get me wrong, but the only ones i’ve felt who really listened to me and wanted to hear me (not just nodding and thinking about what complicated test to do or what was for lunch) were family doctors.
In the ED, I have the Command style, which I use during my first few hours, quickly and efficiently seeing a lot of patients. Command=I stand. I jack the bed up, way up, so they’re at at least eye level with their family in the room, and usually higher, but I don’t sit. It sounds rude, but I’m in a hurry.
When I go back for one of my several re-evals, and especially for the discharge chat, I sit unless there are no chairs, and I do note a difference in the interaction.
This isn’t universal (the obnoxious patient may not get the whole treatment), but it stands (pun intended): sit to be heard.