How far does compassion go? 5 spine surgeons on bedside manner

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: Why did you decide to become a spine surgeon?

 
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, Oct. 15, at 5 p.m. CST.

Question: What are some of the ways in which spine surgeons can improve bedside manner?

Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: Listen to the patient. Listen to what they have to say and be honest with them. Take time to explain to patients what the problem is and then give them choices for treatments and let them know what your choice is. But let them make the decision.  

Hooman M. Melamed, MD, Orthopedic Spine Surgeon, DISC Sports & Spine Center, Marina del Rey, Calif.: First, be willing to listen to your patients. A lot of times, problems occur when the surgeon does all the talking without really listening to the patient before walking out. A better bedside manner allows the patient to talk and get their story out. When you listen to the patient, they have confidence that you're taking them seriously.

Second, make yourself available to your patients, even when you have a complication or may not know all the answers. Don't disappear or let ego get in the way of asking for help. Remember, you're doing the right thing for the patient, even if it means conferring with another surgeon or specialist when you don't know the answer yourself. Your patients will be thankful for that.

Brian R. Gantwerker, MD, The Craniospinal Center of Los Angeles: I focus on getting to know the patient, understanding why they came in. If you can explain your indications and what your expectations for their improvement, you can really solidify your connection to them. Listen patiently, and address each question.  Rephrase their question in giving your answer. Make sure you have gotten all their issues addressed before leaving the room.     

Richard Guyer, MD, Co-Founder, Texas Back Institute, Chairman, Texas Back Institute Research Foundation (Plano): To some spine surgeons, a good beside manner comes naturally. However, there are certain tips that can help one improve the patient's experience.

•    When they walk into a room, the first thing that the surgeon should do is to introduce themselves with a smile and shake the patient's hand. I like to start with some small talk — who referred them, if it was a patient of mine, etc., to relax the patient.
•    The surgeon should sit down and let the patient tell them what is wrong, regardless of if they work with a PA or fellow. It is very important that you maintain eye contact with the patient during this time. Do not look at your smart phone and excuse yourself from the room if you have a message that has to be answered. The worst things that I hear about other physicians are that "the surgeon walked in, said that I needed to have surgery and then walked out without examining me, sending in his surgery scheduler." To me, that is not good medical care, nor is it the type of medicine that I think that anyone, physician or patients, really wants.
•    If I am running behind in clinic, after introducing myself, I always apologize for making them wait. The patient's time is just as important as yours. Again, patients like to see that you have humility and compassion.   
•    Even though, your medical extender may have done a complete examination, I always go through a few things just for the "touch connection" of the physician with the patient.   
•    Whether you use electronic medical records or a Dictaphone, it is extremely important that your back is never to the patient. In my practice, for example, I do not chart my patient's EMR while in the exam room for that reason alone. When I used to dictate, I would explain to the patient that I am dictating in front of them, while maintaining eye contact, so that I could reinforce the things we had discussed.
•    At the very end of the visit, I always explain to the patient what I think is wrong in simple layman terms and what I recommend to get them better. I then always ask them if they understand and, lastly, if they have any questions.  
•    The very last thing that one should do is either shake the patient's hand or put your arm around them and tell them how nice it was to meet them and that you are going to do your best to get them better.  I do the same thing even if it is a patient I can't help by saying, "You are a really nice person and I wish I could help you, but unfortunately I, personally, cannot." I will give them suggestions as to where else to seek help. The main thing is to show the patient that you are sincere and compassionate.   
•    Even though you might have many things running through your mind, or worrying about a patient issue, you have to be able to compartmentalize while you are in that room and give the patient your undivided attention.  

Gowriharan Thaiyananthan, MD, Founder, BASIC Spine (Newport Beach, Calif.): Pretending that each patient is a family member is a good mental exercise. Oftentimes we may see a singular patient as one patient in a packed clinic, but for that patient we are the person they most likely have been waiting weeks to see. Also, reflecting on the times that we have been patients and then understanding the experience from the "other side," I believe, can make us more sympathetic to the experiences that our patients are going through.  

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