Better Bedside Manners

http://www.time.com/time/health/article/0,8599,1659065,00.html

by Laura Blue

Every patient wants to find a doctor who listens. But wouldn't it be easier if all doctors were just better listeners? A new paper in the Sept. 5 issue of the Journal of the American Medical Association suggests that it might not be so hard to make it happen: in the first comprehensive study of clinical-skills exams given to doctors, researchers from McGill University in Montreal show that poor scores in the communication portion of the test are highly predictive of which new doctors are likely to clash with patients in the future. By evaluating communication skills early on, say the study's authors, physicians and academics can better train and select the next generation of medical professionals. The exam, which was rolled out between 1992 and 1993, requires doctors to interact with actors posing as patients in a series of standardized scenarios; trained physician evaluators then judge how well the doctor takes patient histories, makes diagnoses, manages treatment and communicates with the patients. When researchers followed up with the doctors in 2005, they found that the docs' scores in communication were strongly correlated to the number of patient complaints they had racked up in their first years of practice.

The physicians who scored low on the test — the poor communicators, who were, say condescending, judgmental or flippant in their behavior — had generated a disproportionate number of those complaints. No surprise: the link between poor test scores and patient complaints was strongest when it came to doctors' style of communication and attitude — the way a doctor tells a patient he has cancer, for example, or whether a doctor ignores a mother's description of what ails her child. When Canada first mandated that doctors pass the communication test for licensure, it was the only country in the world to do so — and the move was seen as controversial. Since then, the U.S. licensing system has also introduced a clinical skills exam, which every domestic and foreign medical school graduate must pass. While few physicians or educators doubt that communication matters, many people question how well you can test something as subjective as communication — especially when every new doctor must complete the exam on a single given day, no matter how grouchy he or she feels. If we know how to evaluate what makes a good doctor, after all, maybe we can produce bette ones. "This could diminish quite substantially the number of complaints," says Tamblyn.