Good manners are paramount in all walks of life, and are especially important in difficult circumstances, where they can be used to acknowledge and assuage feelings of anxiety, impatience and frustration. An obvious aspect of this is the interactions, whether they are in a GP’s surgery or a hospital, between doctors and patients. The ability of a good doctor to soothe, reassure and placate an anxious patient is referred to as his/her ‘bedside manner’.
Good bedside manners are not explicitly taught in our medical educational system, but it is to be hoped that they are effectively modelled by senior doctors. Our health service is under increasing pressure, however, and it would not be surprising if the strains of operating within it, coping with an ever-increasing workload and navigating a creaking bureaucracy all conspire to erode day-to-day social niceties. When harassed doctors are wrangling life and death issues, they might feel that good manners are the least of their concerns.
But we would argue that a keen sense of empathy, an ability to recognise the anxieties and concerns of the patient, and a respect for each patient as a unique individual – the cornerstone of good manners – are all attributes of excellent and effective doctors. There are several ways in which good manners and good healthcare can intersect for the benefit of both patients and doctors:
When patients are feeling ill at ease, consultations can be normalised by small talk. It goes without saying that patients should always be greeted politely with a ‘Good morning’, ‘Good afternoon’ and, if necessary, an introduction. They should be politely offered a seat. These minimal formalities should never by rushed or overlooked.
Engaging with a patient for a few minutes on general topics demonstrates an interest in the individual and helps them relax. It makes the whole experience feel less transactional and will build feelings of trust and confidence. Mutual observations are a good place to start and the most obvious topic, especially in Britain, is the weather. It might seem like a clichéd subject, but most people will enjoy chatting about torrential downpours, droughts, cold snaps and heat waves. Alternatively, comments about the general surroundings (eg “What do you think of the new hospital building?”), or asking someone how they travelled to their appointment, are other ways of relating to people, as well as finding out more about them.
Every encounter with a doctor is of vital importance to the patient and they will be sifting a battery of first impressions, seeking reassurance. Negative body language – putting hands in pockets, fiddling with hair or beard, lolling, yawning, eye-rubbing, face-stroking – can be extremely off-putting. They radiate feelings of exhaustion, boredom, preoccupation, non-engagement. Above all they project a lack of focus, which every patient craves.
Doctors should make a conscious effort to project positive body language: sitting up straight, maintaining good eye contact (but not staring), leaning in towards the patient rather than lolling backwards, nodding affirmatively to demonstrate interest. Above all, in this digital age, doctors should resist the compulsion to stare, transfixed, at their screen, rather than looking at the patient.
‘Talking down’ to other people from a position of perceived authority or presuming to ‘explain’ when no explanation is needed or sought, can make patients and their carers feel that they are not worthy of respect.
Telltale signs of being patronising include: feeling an irresistible urge to correct people perceived to be wrong, whatever the circumstances; being an inveterate interrupter, who interjects with their opinions and tends to take over the conversation; a tendency to bombard people with obscure facts and nuggets of information in order to appear knowledgeable and well-informed; a tendency to make the assumption that most people are less intelligent than oneself.
Any behaviour that focuses on highlighting other people’s perceived inferiority is the antithesis of good manners. Instead, doctors should focus on nurturing and encouraging the people who are seeking treatment and making them feel good about themselves, rather than demeaned. A good starting point is to really listen to what people are saying and curb any tendency to make belittling assumptions about people’s experience, capacity and expertise. It is always rude to assume that people are fundamentally ignorant, and it is recommended that doctors make it a rule to ask, “Do you know about X?” before launching into an unnecessary explanation.
Inevitably, there will be times during the process of hospitalisation or medical care that patients experience oversights or mistakes, such as lost notes, misdiagnoses and failed procedures. Given that this is inevitable, it is essential that the medical profession learns the art of a genuine apology.
When a mistake or oversight that affects the patient has been made, it is the duty of the doctor to honestly admit the error and apologise, even if the offence is not the personal responsibility of that doctor. The important thing is to acknowledge the inconvenience (or worse) that the patient has suffered; even if the offence cannot be mitigated, the patient will always feel better if it is recognised.
When it comes to saying sorry, the most common mistake is to apologise ‘if’ the patient has suffered offence or upset; the use of the word ‘if’ clearly implies that the person who is making the apology does not recognise the legitimacy of the offence and assumes that the patient who feels wronged is insisting on feeling mistreated or disregarded. This attitude can compound, rather than alleviate, negative feelings towards the medical profession.
A genuine apology fully recognises the nature of the offence, acknowledges the pain or discomfort that has been caused and seeks forgiveness from the person who feels wronged: (“I am so sorry we had to cancel this procedure at such short notice. I do realise this must have been very difficult for you, and we will do everything we can to move your treatment forward promptly”).
The NHS Ten-Year Plan emphasises the key importance of digital healthcare in the coming years, encompassing AI technology, robotics and enhancing the NHS app.
While the benefits of these new ways of communicating may seem obvious, some people still regard new technology with fear and suspicion and when they are breezily advised to “just pop in your details online” or told “it’s really easy to sign up online”, their feelings of anxiety and disenfranchisement will be increased. While most of the population now owns a smartphone, a significant proportion of people aged over 65 (27 per cent) do not have a smartphone or internet access in their homes. So it is inconsiderate, on the part of the medical profession, to make assumptions about people’s access or comfort with online resources, or their willingness to engage online or through their phones.
In a digital world, it is always important to remember that there are still many people who live their lives in an analogue way. They may have problems receiving or reading texts from the doctors’ surgery on the phone (eyesight problems or difficulty mastering the technology) and may certainly find invitations to “go online for a telephone appointment” daunting. It is always advisable not to make assumptions about their digital literacy, and to make polite and tentative enquiries about their technical competence at the outset (“Are you comfortable receiving texts?” or “Are you happy using the internet?”). The important thing is to make them feel that you are recognising their preference, not patronising them or making them feel inadequate.
The image of the august consultant, who patrols the wards with an entourage of eager and sycophantic acolytes, discusses his patient’s symptoms with arrogant disdain and never deigning to interact with them as individuals, is a comedy cliché. But it has emerged from the widely held perception that many doctors lack basic communication skills, which makes them incapable of interacting effectively with their patients or alleviating their anxiety.
Every encounter between a doctor and a patient involves myriad nuances of behaviour. Patients who are already anxious and concerned about their health may well have experienced frustrating delays and difficulties in gaining access to a doctor and will therefore be more than usually sensitive to language, gestures, facial expressions and demeanour. They may well fear that they are going to be patronised or condescended to by medical professionals and will require reassurance.
Good bedside manners are an effective way of alleviating all these concerns. If a doctor is polite and courteous, able to make relaxing and distracting small talk, capable of listening attentively to what they are being told and wary of making assumptions about their patients, the whole experience is likely to be much more positive.
Above all, doctors must be encouraged to see their patients as individuals, with their own experience, eccentricities, characters and life stories. All too often, patients complain of being objectified, or being seen as a collection of symptoms rather than a human being. In a digitalised world, where patient consultations are moving online and face-to-face encounters are diminishing, the vital social skills that doctors need to demonstrate their humanity, are being eroded or sidelined. It is to be hoped that a renewed emphasis will be place on training medical professionals in the social skills and common courtesies that should enhance every consultation.
