Bedside manner remains vitally important during the pandemic

Reviewing the latest numbers from the Centers for Disease Control and Prevention and the rapid emergence of new variants of the virus, it’s clear that COVID-19 will be part of our nation’s reality for the near future. Physicians are well-aware of the culture shift taking place in health care settings to assist patients that are currently infected, while simultaneously implementing measures to control the spread to other individuals seeking care services. The term “bedside manner” is also transitioning from a new requirement to a “new normal”, including precautions for personal protective equipment (PPE) that hide provider faces from our patients, distancing measures that keep physicians a bit farther than “bedside,” and limitations on visitors that can provide much needed comfort to patients who are at their most vulnerable.

As an OB hospitalist, I work with a number of different hospitals throughout the New York area, overseeing care teams in the labor and delivery room, and helping those teams adapt to the challenges of providing good patient care during this pandemic. For labor and delivery rooms in particular, what is usually an occasion filled with joy and family has been transformed into a more austere and somber environment, with limitations on the number of people that can be present during the birth and a number of precautionary measures in place to ensure the safety of both the mother and the healthcare providers attending her.

In light of the most recent information from the Centers for Disease Control and Prevention that shows pregnant women at a higher risk of hospitalization and complications when it comes to COVID-19, coupled with the continuing lack of information about the safety of the vaccine for pregnant women, it’s more important than ever to enforce safety measures to protect both mother and infant, while not losing sight of the humanity of their experience and emotional needs.

It’s been a number of years since I completed medical school, and for many doctors in my generation, bedside manner was usually a subject that was practiced but not taught. Over the years, I have learned that it’s an absolutely critical skillset. Effective bedside manner is facilitated by the physician and is designed to provide compassionate care and build a basis of trust. With COVID-19 numbers continuing to rise and uncertainty still on the horizon even as vaccines are distributed, it is more important than ever for physicians to keep bedside manner top of mind.

For hospital-based clinicians, the following three questions can help in evaluating our performance when it comes to patient bedside manner:

Did I take time to do my homework?

In the OB hospitalist environment, we often enter the labor and delivery room and OBED triage area with minimal prior engagement with the patient. In the COVID-19 hospital environment, patients are likely to feel even more vulnerable and anxious. Mispronouncing a name or misreading encounter information can thwart a relationship before it even has the chance to begin. Taking a few extra moments to confirm how to pronounce your patient’s name if you’re unsure and discussing patient history notes from nursing staff quickly to make sure you’re aware of any concerns can make a huge difference in helping the patient feel a genuine connection.

Am I making an effort to enhance physical cues?

Body language is a bit different in the COVID-19 world, especially in situations requiring an extensive amount of PPE that cover our mouths and prevent us from physically interacting with the patient as much as we normally would. Smiling can still go a long way, as patients can see it in your eyes and hear it in your voice, even if it’s not visible. Making eye contact and displaying your name badge with a photo of your smiling face can also help to remind patients of the person helping them beneath the PPE.

Do I appear rushed?

The extra steps needed in today’s hospital environment can translate into physician stress as well. While we may feel pressure to hurry, this should not be something that is apparent to the patient. In addition, rushing can lead to medical errors. Take time to be fully present. Show the patient you are engaged by sitting down to be at eye level (even if spaced apart), uncross your arms, and make eye contact.

Taking time to assess our current practices when it comes to bedside manner and identifying areas where we can improve the personal responses that accompany our clinical best practices can make a world of difference in improving patient communications and providing the human social connections necessary for practicing good medicine. As we work towards curbing the spread of COVID-19 through vaccine distribution and adapting health services to meet new demands presented by the virus, keeping in mind how we balance protective measures with the emotional needs of our patients will only help us to improve the care continuum, both during and well after the pandemic.

_{About the Author}

_{Nicholas Kulbida, MD, is a hospitalist and Medical Director of Operations for the Ob Hospitalist Group. He is based out of Schenectady, New York.}