July 14, 2016

High-quality care: The importance of being human


Samantha on the soccer field.

Susan Brandzel reflects on what patients really need from providers. Clinical competence is essential, but so is being engaging, compassionate and real.

by Susan Brandzel, MPH, Group Health Research Institute research project manager

When my 13-year-old daughter recently sustained a serious back injury, she was devastated. Soccer is her physical outlet, her social life, and her passion. I could almost literally see her heart sink when the orthopedist delivered the news about her injury and long recovery.

We recently had a follow-up visit with her orthopedist. As Samantha nervously waited in his exam room, clearly anticipating what he would say about the prognosis for her soccer, I mean her back, she asked me whether she could draw on the dry-erase board on the wall. With my permission, she initiated a game of hangman. But just after setting up the game, the doctor and nurse practitioner came into the room. My daughter quickly returned the pen to its tray, and self-consciously looked at the doc, concerned that she was going to get in trouble for drawing on the board. But instead, he smiled and enthusiastically declared, “Oh, good! Let’s play hangman!” The four of us proceeded to play the game until the word was revealed.

The exam itself was straightforward. My daughter’s pain was decreasing and her strength increasing. She was on the mend. We thanked the doctor for the good news, expecting him to quickly dismiss himself to see his next patient. Instead, he got a glint in his eye and announced, “Wait! I have another word!” And he set up another game of hangman, with four blanks. After a few minutes, his word was finally guessed. It was “onyx,” a semiprecious gemstone.

As we departed the clinic, my daughter and I both had a spring in our step. Not only were we thrilled by the news of her improved health, but the interaction we had with her doctor was downright fun. We marveled at his humanness and the time he took with us. We talked about how much we wished that this visit was exemplary of all health care visits. It felt complete and satisfying.

The science of humanness

In his article “Physician behavior and bedside manners: the influence of William Osler and The Johns Hopkins School of Medicine,” Dr. Barry Silverman cites the longtime hero of bedside manner, Sir William Osler. Dr. Silverman reflects that, as early as 1892, when Osler’s textbook The Principles and Practice of Medicine was published, an egalitarian and compassionate approach to the practice of medicine was considered important.

A 2014 survey found that patients judged a doctor’s quality based on personality and the patient-physician relationship more than the effectiveness of the care they received. And while I don’t believe that anyone wants care from a provider with subpar clinical skills, one of the takeaways from this survey is that patients need to have respectful and genuine interactions with health care providers to feel that they are truly being cared for.

Health care providers are under enormous pressure to keep visit duration to a minimum, see as many patients as possible, and maximize efficiency. And while these practices may be somewhat necessary to keep health care systems functioning, we need to make sure that the emotional side, including the primary human need to feel comforted and cared for, is not lost.

Group Health Research Institute does extensive research to help make care delivery simultaneously personal and effective. Dr. Jessica Chubak, for example, is researching the impact of having animals visit pediatric oncology patients in the hospital. Dr. Andrea Hartzler is designing technology to help providers be more empathic toward patients through the use of nonverbal cues. And Dr. Eric B. Larson has explored empathy in patient-provider communication. These are examples of how scientists here are trying to make health care more human and have better health outcomes.

My daughter’s orthopedist clearly sees the importance of the human side of practicing medicine. His hangman word may have been “onyx,” but his style was good as gold.