by Shawn Kirby

Treating patients is a complicated undertaking that requires multiple skill sets. Being a good practitioner is about much more than academics or even hands-on practical skill – ultimately it is about effectively interacting with another human being. You may have been the best student in your class. You may have an agile mind filled with every conceivable piece of TCM trivia known to mankind. You may even be an old salt who’s seen it all, and thinks they know the business of TCM backwards and forwards. But if you have a lousy bedside manner, you probably aren’t doing your patients much good, if you’re doing them any good at all. Numerous recent studies indicate that, “The patient’s perception of provider bedside manner directly impacts health status, satisfaction, and compliance.” 1 (my italics) In other words, how you are perceived as a practitioner has a direct bearing on your patient’s health. The question then becomes, what constitutes a good beside manner? What is it that patient’s need from their interactions with their health care providers, and how do we go about giving that to them?

Follow up:

Listen, don’t Lecture

The first thing we need to do to cultivate a good bedside manner is to emphasize listening over lecturing at all times. Quite honestly, as a patient of both numerous western medical physicians and alternative healthcare practitioners over the years, I feel that the western medical profession has us beat hands down in this department. Perhaps I’ve just had an unusual run of luck, but every western medical professional I’ve worked with has always put the emphasis on hearing me out, answering my questions, and letting me make my own decision about my health. In direct contrast I’ve been to numerous practitioners in the alternative health care field who treated me more as a potential convert to their ideology than as a patient, were bizarrely judgmental, and hardly let me get a word in edgewise. Over the years I’ve been bullied, harangued and downright harassed, not by my doctor, but by most of the alternative healthcare providers I’ve been to. And nowhere is this unfortunate trend more out of control than in regard to diet and lifestyle choices.

Whether you are privileged to live in a state where you are considered a primary care provider or not, diet and lifestyle choices are up to the patient, not to you. Even if you feel that a dietary issue or lifestyle choice is the cause of the problem, your job is to inform first, advise second, and then let them make their own decision based on this information. Chewing your patient’s ass is not good healthcare.

IF my patient has a condition that in my professional opinion (and by the way, reading up on the latest idiotic diet fad at Barnes and Noble does not constitute a professional opinion) would respond to a change of diet, and IF my patient also asks for advice on their diet then, and only then, do I offer such advice. I know for a fact that this is unusual, because I’ve had a number of patients ask me at the end of the treatment, “aren’t you going to talk to me about my diet?’ When I reply, “what would you like to discuss about your diet?” they are both flabbergasted and pleasantly surprised, particularly if they’ve been to see other alternative health care providers before me. I know for a fact that this approach fosters ten times the patient compliance later on down the line than if I had pushed my own agenda, because I’ve done it both ways.

Use a Common Frame of Reference

Establishing and maintaining a common frame of reference is vital to help your patient feel that there is open and transparent communication between patient and practitioner. You need to find common ground with your patient, particularly when it comes to discussing their case with them. If your patient doesn’t feel that they know what’s going on, they are not receiving adequate care.

In all the years that I studied with my herbal instructor and mentor, a Chinese born TCM doctor, I never once saw her use TCM terminology with a patient. No matter what TCM diagnosis she came up with, she always found a way to couch the information in a way that her patient could understand and trust. Sometimes this meant taking a TCM concept and putting it in “layman’s terms.” For instance, on the rare occasion that she felt the need to discuss qi, she would always talk about the body’s “energy.” If the patient was skeptical of this term, she would quickly move to discussing the body’s ability to self correct, and talk about encouraging the healing process. Never once did I hear the word “qi” escape her lips. At other times she would fall back onto her knowledge of western physiology and give the patient an approximation of what she was trying to convey using these ideas. Rather than telling someone that “Ren Shen” would “supplement their spleen” she would tell them that ginseng would benefit their overall endocrine system, particularly their pancreatic function which would help their digestion.

As a supervisor, she never tolerated her interns blinding their patients with TCM pseudo-science. I remember her dressing down an intern in the hallway after observing them doing an intake –

“Why did you talk for half an hour about spleen qi xu?! Your patient’s eyes were glazed over! Your patient doesn’t care about Chinese medical theory! YOU don’t understand Chinese medical theory, and you are a student of Chinese medicine! How you expect them to get it?! (She rarely pulled any punches.) Just tell them that they have weak digestion from stress and they need to chill out! You American students make everything too hard!”

Small Acts of Kindness

Having appropriate boundaries with our patients is a common problem in our industry. While western physicians are too often seen as cold and uncaring, all too often we swing too far in the opposite direction. While you should not be cold and callous with your patients, you cannot befriend them either. It’s a difficult balancing act, yet it can be done effectively and gracefully.

While it is important to set and establish firm boundaries with all of your patients, you can then temper these boundaries with simple and small acts of kindness. Asking about a patient’s comfort, for instance, can dramatically improve a practitioner/patient interaction. Inquire about temperature levels, provide a blanket, or a heat lamp. Ask them how their weekend was. Take an interest in a hobby, and keep this information on a post-it in their chart. These things allow you to show your compassion in an appropriate way.

Sources

1.http://www.ispub.com/journal/the_internet_journal_of_advanced_nursing_practice/volume_10_number_1_8/article/bedside_manner_concept_analysis_and_impact_on_advanced_nursing_practice.html

http://www.carepages.com/blogs/bedsidemanner/posts/whats-a-good-bedside-manner-and-why-does-it-matter