My Bedside Manner Got Worse During The Pandemic. Here’s How I Improved
Saturday, May 16, 2020
"Come in," Ms. H calls out.
I step into her room triple-protected — wearing my N95 mask, a surgical mask and an eye shield. I introduce myself as her doctor, my voice barely audible among the chorus of loud alarms blaring from a hospital monitor. It's signaling that her IV infusion has finished.
I tune out the sounds — I hear them all the time — but I can tell that she is frustrated. She's not getting any sleep or rest. I glance at the monitor and quickly press "silence," giving her momentary relief from the noise.
In a momentary lapse, I hold out my hand for a handshake, then pull it back. "How are you doing?" I ask instead. The pain medications are not working very well, she tells me. I frown, but my downturned mouth is hidden beneath my three masks. All she can see are my eyes, and even then, she sees them through the glare of the protective shield.
Ms. H had come to our hospital in bad shape. She had significant bleeding inside her abdomen, requiring my colleagues to perform emergency life-saving surgery. Many patients do not survive what she's gone through, and I'm relieved just to see her alive. Still, I'm also upset to see her in so much pain.
"Hang in there," I tell her as I leave. It feels as if I'm talking to myself as much as to her.
The encounter was frustrating. From the very early stages of our medical training, we are taught about the importance of bedside manners. Eye contact. Smile. Perhaps a handshake or a pat on the shoulder.
These gestures can be as simple as sitting in a veteran's room for an extra five minutes to listen to World War II stories. Or listening with a young cancer patient to a song by our shared favorite band. Or clutching a sick patient's shoulder and reassuring him that he will see his three daughters again.
These gestures acknowledge a patient's humanity. It gives them some semblance of normalcy in an otherwise difficult period in their lives. Selfishly, that human connection also helps us — the doctors, nurses and other health care providers — deal with the often frustrating nature of our stressful jobs.
Since the start of the pandemic, our bedside interactions have had to be radically different. Against our instincts, and in order to protect our patients and colleagues, we tend to spend only the necessary amount of time in our patients' rooms. And once inside, we try to keep some distance. I have stopped holding my patients' hands. I now try to minimize small talk. No more whimsical conversational detours.
Our interactions now are more direct and short. I have, more than once, felt guilty for how quickly I've left a patient's room. This guilt is worsened, knowing that patients in hospitals don't have family and friends with them now either. Doctors are supposed to be there for our patients, but it's become harder than ever in recent months.
I understand why these changes are needed. As I move through several hospital floors, I could unwittingly transmit the virus if I'm infected and don't know it. I'm relatively young and healthy, so if I get the disease, I will likely recover. But what about my patients? Some have compromised immune systems. Most are elderly and have more than one high-risk medical condition. I could never forgive myself if I gave one of my patients COVID-19.
So I am excessively careful.
As always, we must adapt during tough times. If we want to preserve the bedside manners that can help our patients heal, our words matter more than ever.
"I am here for you."
"I want you to know that I will do everything I can to make you better."
"What can I do to make you more comfortable?"
"Did what I just talked about make sense? Did you want me to repeat anything?"
I have relied on these words in recent times. And it works. Patients, almost universally, appreciate the extra effort, and it paves the way for good rapport.
Beyond what we say, there are other ways to maintain good bedside manners. I have started showing my ID badge — which has my picture — to every patient I meet, so they know what I really look like. I have become mindful of leaving the room more ergonomically helpful for my patients than when I entered — such as moving the call bell or the bedside table within their reach.
Some of my colleagues have started pausing to call into patient rooms as they walk by throughout the day — just to check in on them more often. Most patients say these changes make a difference.
It's certainly made a difference for Ms. H. The day after my first visit, I stand outside her closed door, putting on protective gear, and place my ear a few inches from the door before entering. No alarms this time.
She invites me in — and looks a lot better. She finally got some sleep, Ms. H tells me, but she wishes that the hospital food tasted better. I instantly relate, letting out a laugh. She seems to be in good spirits.
"Thank you, doctor, for what you are doing," she says as I get ready to step out. I look up to see her smiling. I smile back.
"You just made my day, Ms. H, so thank you," I tell her. As I close the door behind me, I, too, am feeling more optimistic. Together, we are getting through this pandemic and its forced estrangement, day by day. Soon enough, everything will be OK.
Dr. Shahdabul Faraz is a resident physician in the Department of Surgery at Beth Israel Deaconess Medical Center, a teaching hospital of Harvard Medical School. He'll also start studies at Harvard Business School in the fall. His writings have appeared in "The New York Times", CNN and New York's "Daily News."
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