Back to basics: A better job of caring

Joe Pellicer
For The Olympian

I recently attended a refreshingly different medical conference. Instead of t eaching about diagnosis and treatment, it taught us about the art and science of service excellence in the practice of medicine.

As medicine has evolved from its cultish past into a multibillion dollar industry, too many physicians have considered themselves exempt from rules that apply to any other service industry, believing that we could get away with being late, aloof, preoccupied or even rude for any number of specious reasons.

This is no longer the case. We learned that doctors, nurses and the whole team of professionals that make up a modern hospital or clinic have a lot to learn when it comes to caring for patients.

We learned it is not sufficient to just be clinically competent. Our patients increasingly demand that they be treated with the same quality of care that they would expect from a fine hotel or restaurant. While this might at first seem trite or even demeaning to our noble profession, it couldn’t be further from the truth. This is good for medicine.

The basics are embarrassingly simple and obvious: basic civility from a bygone era when most physicians took the time to actually talk to their patients. But the truth is that with increasing pressure to see more patients, be technically correct 100 percent of the time and be diligent in one’s documentation, attention to small details of interpersonal relations are forgotten or ignored.

This starts with introductions. It is not only rude but poor medical practice for me to enter an exam room, expect to be automatically recognized as the physician, and, while standing at the bedside looking down at my clipboard, launch into taking your history.

Research and common sense show you are much more likely to trust me if I do three simple things: introduce myself, shake your hand while I meet your gaze, then sit down to listen to you.

People want to be listened to – what a reasonable concept! A study was done on physician listening skills. The average doctor will interrupt a patient within 18 seconds when they are giving the history of their problem.

People want to be respected and involved in the decisions affecting their bodies. Here is an area where we still are too similar to the priest-like physicians of old. Another study showed 90 percent of patients do not participate in their own treatment plans – usually because they weren’t invited to.

Like many other businesses, medicine is learning to use surveys to measure how satisfied its customers are.

The results are bracing: Many of our patients think we do only an average job of listening, showing respect and caring – attributes that should be the expected norm of medical care.

While some physicians bridle at the concept of being “rated” by their patients, more and more of us are realizing that, if we just pay attention to what our patients are trying to tell us, these tools will make us better doctors.

An ironic insight into the problem is that when similar surveys are administered to doctors, we consistently overrate ourselves in the very categories where our patients think we need to improve.

The underlying concept is not that the technical skills we have to offer are not important, but that when combined with attentive interpersonal skills, we are so much more effective in achieving the mutual goal of healing.

I left the conference both inspired and sobered. While I am thoroughly convinced that routinely incorporating these ideas into my practice will make me a better doctor, I know how difficult it can be to sit patiently and listen to my patient’s story about back pain at 3 in the morning when I have six other patients who are much more ill.

During the past year, we have begun the work of instilling the concepts of service excellence not only in our busy emergency department but throughout our hospital. We are making progress, but we still have much work to do.

I invite and challenge any of you who use our services to hold us to the highest standards, not only of clinical excellence, but those equally important qualities of listening, caring and respect.

Dr. Joe Pellicer is a physician at Providence St. Peter Emergency Department. Dr. Tom Burke is the director of the Center for Global Health at Massachusetts General Hospital and a Harvard University faculty in emergency medicine. Please go to for more information or to contact the doctors.

Editor’s note: This article originally appeared on The Olympian’s website. It has been removed but we will keep it here for archiving purposes.

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