- The Washington Times - Sunday, July 13, 2003

The exam room may never be the same again: New research finds that Americans are most comfortable with the kindly demeanor of an “old-fashioned” doctor, complete with an empathetic ear and traditional white lab coat.

Doctors are rising to the challenge. Beginning next year, graduating medical students must pass a “bedside manner” test to get their licenses.

And no wonder.

The Federation of State Medical Boards and the National Board of Medical Examiners, which conduct the licensing examinations, have surveyed more than 1,000 people to find that 97 percent feel a doctor’s ability to simply listen is “extremely” or “very” important to them.

And 87 percent said doctors should have to pass an exam that tests their bedside manner.

Respondents will get their wish.

The exam, which took the two licensing groups 15 years to develop, will take aspiring doctors a full day to complete and includes actors who mimic patients in various states of distress.

“We need a national standard so the American public knows their physicians enter practice with core competencies,” said Dr. James Thompson, FSMB spokesman. “This exam will establish that standard.”

American physicians have not been measured on such “clinical skills” since 1964, when the segment was dropped from exams because officials felt the test lacked objectivity.

Time has proven, however, that a doctor’s attitude can affect business and the profession itself.

“A large body of literature has shown that poor communication skills and interpersonal and general clinical skills are related to a higher incidence of malpractice suits, lower treatment compliance by patients and decreased patient satisfaction,” the FSMB noted in a statement.

Medical schools are taking the touchy-feely aspect of the healing arts seriously.

Indiana University School of Medicine has just embarked on a $2 million research project that will explore “relationship-centered care” focusing on “the same principles as the old-fashioned bedside manner of simpler times,” a statement said.

The University of Arizona Medical School offers a course for “human nonverbal interaction at bedside,” which sends medical students to a Tucson ranch. Doctors in training are taught to analyze the reactions of horses to threatening human gestures, and thus sensitize themselves to their own body language.

The University of Rochester Medical Center in New York, meanwhile, opened the Rochester Center to Improve Communication in Health Care on June 26 to study the effects of doctors’ communications skills. Researchers say health care costs already have dropped by 4 percent thanks to doctor-patient rapport.

“You can’t be the best physician in the world if you can’t communicate,” said director Dr. Ron Epstein.

Three out of four medical schools require students to take art, literature or other humanities courses to enhance their emotional disposition or hone powers of observation, the Association of American Medical Colleges says.

It is a way, spokesman Brownell Anderson told the Los Angeles Times, to restore “the art in the art of medicine.”

One doctor, however, said his fellow physicians have overlooked the power of their own sartorial demeanor.

Weary of healers decked out in polo shirts, jeans and stethoscopes, Dr. Lawrence Brandt urges his profession to return to the traditional wardrobe of starched collars, pressed pants and spotless white lab coat — with name tag.

Writing in the Archives of Internal Medicine, the New York gastroenterologist revealed patients in every age group and region prefer the old-fashioned, white-coated image, based on his evaluation of 31 different studies.

But bedside manner still takes precedence over wardrobe.

Even a white coat is no substitute for “a gentle, concerned physician with an engaging, friendly, empathic demeanor,” Dr. Brandt wrote.


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