Can Bedside Manner Be Taught
Learning Empathetic Communication Through Simulation
When hospitalist Christine Bryson, MD served as a liaison for her critically ill cousin, she was struck by the remarkable variation in doctors' abilities to talk about difficult and emotional issues with patients and their families. She created a simulation project for residency interns to practice their empathy skills during these challenging discussions.
Code status discussions—talking to patients and families about life sustaining interventions and goals of care—are essential for helping physicians provide appropriate care and avoid unwanted interventions. But, listening to her cousin's doctors trying to explain what was happening, she noticed a remarkable variation in their ability, and willingness, to communicate with empathy.
Doctors More Comfortable 'Speaking Medical'
Code status discussions are a frequent occurrence for residents in the hospital. But they generally lack the knowledge and confidence to effectively facilitate these discussions. There isn't a standardized medical school curriculum for communicating with patients about code status or end-of-life care, Bryson notes.
She recalls her cousin’s husband telling her that “doctors looked more comfortable 'speaking medical' to her.”
The simulation experience, taken by all internal medicine and medicine-pediatric interns, is designed to help them understand not just how to have a code status discussion, but to hear from a volunteer patient how it makes them feel.
The program has interns think through what they are going to say, how they will say it, and walk through it ahead of time so they can go in with a thoughtful approach.
Real Patients Give Feedback to Guide Learning
According to Bryson, other training programs do similar things, but Baystate's program is unusual because real patients from the Baystate Patient Family Advisory Committee are trained to participate.
PFAC volunteers learn about code status discussions and are trained to play a specific role, for example a 90 year old with congestive heart failure, as well as how to give feedback to the residents on their performance. Each intern has an individualized simulated code status session that is recorded for them to reflect on later. They also get immediate feedback from the PFAC volunteer, such as, “I didn’t like the way you were sitting, you made me feel talked down to.” Or, “I really liked that you asked about my grand kids.”
Feedback from interns has been positive, reports Bryson.
Increased Satisfaction for Patients and Physicians
“For me it was more important to hear how she felt—listened to or ignored, treated with compassion or with indifference—than telling me how I did,” commented an intern in last year’s program.
Studies have linked empathy to increased satisfaction for both patients and physicians, according to Bryson. So she hopes that finding will convince doctors that it is worth the time.
“I believe when we can acquire empathy it allows us to help patients make better decisions about their health," she concludes. "It allows us to walk with them and their families to the end, realizing we haven’t lost our humanity after all.”