Doctor holding tablet PC talking to patient

Does Bedside Manner Impact Treatment Anxiety & Prevent Individuals from Seeking Care?

“Hello,” I apprehensively greet the C.N.A. preparing to measure my vitals. “Would you mind taking a blind weight for me? It should already be in my chart.”

“A what?” She looks at me blankly.

“Weigh me backwards. It’s marked in my chart I’m to be weighed backwards at each office visit. It’s too emotionally triggering for me to know my weight,” I explain to her.

“Uh, sure. But…I mean, you’re so thin, you don’t have anything to worry about!” She chuckles lightly.

I step on scale, facing away from the numbers that have tormented me for more than 20 years.

“Okay, got it,” she says, scribbling on her clipboard. “Wow, lu-u-u-cky. What’s your secret?”

This verbal transaction obliges me to delve into an awkward explanation of exactly why I am appreciably more disturbed by that particular assessment than the standard patient. But hadn’t I done that preemptively?

For the most part, outside of behavioral health treatment facilities, and sometimes within, patients may not encounter medical personnel particularly sensitive to, or adept at, dealing with the issue of eating disorders or body dysmorphia.

Same visit, same facility. I am now sitting in the office on the licensed clinician discussing my mental health care treatment plan including psychiatric medication management. This is a rotating staff and our first time meeting together so we have not yet built up a doctor-patient rapport. We have had a successful visit up until, ironically, she brings up my current weight. The very same weight which the nursing assistant had just been inappropriately marveling over.

“Your B.M.I. is currently XX and I need it to either be precisely the same and not an ounce less or you to have you gained some by your next appointment,” she says to me. “If you can’t do this, I’ll have you involuntarily hospitalized.

I’ve never responded positively to a threatening approach, particularly in a treatment setting.  Up until that moment, I was completely engaged, responsive, and compliant. However, therapeutic compliance is reliant on an individual’s health maintenance behavior connecting with the recommendations prescribed by their healthcare provider.

In both scenarios, because of poor bedside manner, I felt completely disconnected and uncomfortable with both healthcare providers during the same clinic visit.  Interestingly, they were responding to, and communicating to me about, the same essential factor in my treatment plan that should have been prioritized as an issue to be addressed. However, the lack of sensitivity is not uncommon nor specially reserved for those specifically like me.

Why is bedside manner so important?

Patients begin their healthcare journey in a vulnerable position. I feel this is the case in all branches of medicine, but when it comes to seeking mental healthcare in particular, there is a delicacy in which patient communication should be handled. Many individuals are already hesitant in seeking help because of the societal stigma which remains attached to receiving mental health treatment. Having a therapist or psychiatrist with poor bedside manner as an additional hurdle adds an extra and unnecessary layer of stress for the patient.

Knowing the patient as a person allows the clinician to infer the context of the patient’s physical and emotional health challenges. This is particularly important in the case of mental and behavioral health issues.

One scholarly review summarized that “compliance is good when doctors are emotionally supportive, giving reassurance or respect, and treating patients as an equal partner” and “too little time spent with patients was also likely to threaten patient’s motivation for maintaining therapy.”

Broadly speaking, doctors tend to overestimate their means of communication.  A lot of that has to do with factors which are out of their control. Modern healthcare is such that in-person office visits are run as efficiently as possible. Patients are shuttled in. Appointments are often overbooked, perhaps in anticipation of cancellations and no-shows in order to maximize profits. Offices are run like businesses because it makes financial sense to do so.

Doctors spend less face-time with patients and therefore the patient-clinician relationship suffers or never develops in the first place. Sometimes I have felt so rushed in a doctor’s office, it felt as though I was being a bother asking so many questions!

Furthermore, clinicians may come off as brusque or cold and, I don’t know about you, but that doesn’t really make feel like opening up and sharing about much of anything especially private.

In fact, it trebles my anxiety and apprehension at the prospect of bringing up problems in the first place.

“Physician–patient partnerships are essential when choosing amongst various therapeutic options to maximize adherence. Mutual collaboration fosters greater patient satisfaction, reduces the risks of nonadherence, and improves patients’ healthcare outcomes.”

What are some ways to improve doctor-patient collaboration and communication, reduce treatment anxiety, and help improve patient satisfaction?

Make a List

Whether you are meeting them for the first time or this is a routine session, make an itemized list of questions or concerns you have for your clinician.  It is very easy to get side-tracked, especially in a mental-health care setting.

Keep a Mood Journal

This way, you can explain to your provider how you have been feeling in between sessions without having to struggle to remember.  It is also helpful in tracking how psychotropic medications are working/not working and what (if any) side-effects you are experiencing. This information will be helpful to impart to your provider during your next meeting. This is applicable for both mental health care and your general practitioner-they should be speaking to you about your emotional well-being, at least in broad strokes. Make sure you come prepared!

Do Your Research

If there is a new drug, therapy, or treatment protocol you are interested in exploring, research it thoroughly beforehand and take notes. Bring the information with you to your next meeting to discuss with your provider. They aren’t mind readers and may not know that you would be interested in trying something. Additionally, they may be in a “prescriptive rut” and not realize it.

Be Your Own Advocate

“Medicine is an art whose magic and creative ability have long been recognized as residing in the interpersonal aspects of patient-physician relationship.”

References

Ha, Jennifer Fong, and Nancy Longnecker. “Doctor-Patient Communication: A Review.” The Ochsner Journal 10.1 (2010): 38–43. Print.  Accessed 10 May  2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096184/

Hall J. A., Roter D. L., Rand C. S. Communication of affect between patient and physician. J Health Soc Behav. 1981;22((1)):18–30. (Cross-referenced from PubMed) Accessed 10 May 2017.  https://www.ncbi.nlm.nih.gov/pubmed/7240703

Jin, Jing et al. “Factors Affecting Therapeutic Compliance: A Review from the Patient’s Perspective.” Therapeutics and Clinical Risk Management 4.1 (2008): 269–286. Print.  Accessed 10 May 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2503662/

Martin, Leslie R et al. “The Challenge of Patient Adherence.” Therapeutics and Clinical Risk Management 1.3 (2005): 189–199. Print.  Accessed 10 May 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1661624/

Novella, Steven.  “It’s All In Your Head.”  04 Nov 2009.   Accessed 10 May 2017.  https://sciencebasedmedicine.org/its-all-in-your-head/

Ramsay, Lydia.  “A new kind of doctor’s office charges a monthly fee and doesn’t take insurance — and it could be the future of medicine.”  Business Insider.  03 Mar 2017.  Accessed 10 May 2017.  http://www.businessinsider.com/direct-primary-care-a-no-insurance-healthcare-model-2017-3

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