BECAUSE PATIENTS JUDGE YOUR SKILLS BY YOUR BEDSIDE MANNER
BECAUSE PATIENTS JUDGE YOUR SKILLS BY YOUR BEDSIDE MANNER
It was entertainment night at the senior center. The amazing Claude was appearing that night and the crowd waited anxiously to see the famed hypnotist. When Claude came to the stage, he announced, “Unlike most hypnotists who invite two or three people from the audience to come up and get put into a trance, I intend to hypnotize each and every member of the audience.” He removed a beautiful antique watch from his coat pocket and said, “I want each and every one of you to keep your eye on this antique watch. It’s a very special watch. It has been in my family for six generations.” He began to swing the watch back and forth while quietly chanting, “Watch the watch, watch the watch, watch the watch…” The crowd was mesmerized as they watched the light gleaming off of the bright shiny object. All eyes followed the swaying watch when all of a sudden it slipped from the amazing Claude’s fingers, fell to the floor and shattered into a hundred pieces.
“Crap!” said the hypnotist…
It took three days to clean up the senior center.
The anatomy of comedy finds its essence in the absurd, the ironic, the exaggerated, and the unexpected. The main purpose of comedy is to make us laugh, but it often teaches us lessons, and more importantly, it connects people together in a manner that engenders likeability. Laughter is a priceless involuntary response to visual and/or verbal stimuli.
Everyone loves to laugh and be around funny people. Who doesn’t like a good joke? Humor is the greatest technique for easing the fearful patient, disarming the belligerent patient, and making all of your patients like you.
You don’t have to have been the class clown or the most personable individual to succeed with using humor. Memorizing jokes that you wouldn’t have time to tell in a busy practice is not necessary. Effective comedy can be learned. There are simple lines that work well most of the time.
Most jokes involve two parts: the set up and the punch line. A pause is often used in delivering comedic lines for its ability to magnify the punch line. The difference between a chuckle and a hearty laugh can often be attributed to the proper use of the pause. It’s called timing.
There are some people who are morbidly unhappy, miserable, or otherwise without any sense of humor. They may be depressed, involved in bad relationships, having a bad day, or they may have never learned to appreciate the joys of comedy. Humor is also cultural, so patients from other countries may not always get your jokes or humorous comments. Don’t get discouraged if you use a line from this text and you get a blank stare. Keep trying and you will soon realize you are actually funny.
There are those gifted people for whom a big part of their comedic talent is spontaneous. These are the people we consider funny, not by virtue of memorized lines or reciting formal jokes. These are the people who have a talent for finding humor in things happening at the moment and being able to comment on them instantaneously – they can improvise. Don’t expect to learn how to do this here. That kind of talent takes a special type of brain. Instead, you can learn to deliver funny lines specifically prepared for health-care providers. Once you get the hang of it, you can improvise and customize lines for your practice.
You can learn to deliver funny lines even if others have described you as being a dullard. Just like you learned the Krebs cycle, you can learn to deliver a few select lines. To become proficient you will need to study and practice your newfound skills. You have to use the skills regularly or you will forget them, just like you forgot the Krebs cycle. Once you see how effective humor works, you will never go back to being a boring health-care provider.
If the patient gives you a funny look or if they react in an odd manner to any of your comedy lines don’t be afraid to tell them you are “just kidding.” “Just kidding” confirms that you are a joker and allays any fears felt by patients who either have no sense of humor or who may not get the joke. If the occasional patient doesn’t appreciate your humor, back off and let them experience a bland visit.
The first impression is often the most important. Upon entering the room, you have the opportunity to establish how you will be perceived in the professional relationship. In these thirty seconds you can ease tension, dispel fears, show your humanity, and engender affection.
If you begin by mumbling, “Morning,” you will be perceived, at best, as a quiet reserved practitioner and, at worst, as an unfriendly, burnt-out practitioner. If you enter the room and begin by announcing in a friendly, almost singing, tone, “Good morning, and how are you doing today?” you will be perceived as a friendly, outgoing, happy person. Patients prefer the affable approach to the withdrawn, almost miserable overture.
The introduction is the most important moment of bonding. No matter how warm and friendly you greet the new patient; it doesn’t come close to the positive impact achieved by being able to make them laugh. Your main objective is to make your patient, at minimum, smile and, at best, laugh within thirty seconds.
Begin your greeting in the very expected manner: “Good morning, how are you doing today?”
You must always know what to expect when you ask any question, and with the greeting there are only three general responses you will hear. The patient is either good, bad, or they say nothing. While “no response” from your patient is not typical, it happens on occasion and you have to be ready for anything coming your way.
No Response From The Patient
If you are a psychiatrist treating catatonic patients you can stop with your initial greeting, make some observational notes in the chart, walk out of the room, and bill the State for a comprehensive exam. Assuming your patient isn’t comatose, you can respond to the silent patient:
“Good morning, and how are you doing, today?”
“It’s okay. You can talk to me. I don’t charge by the word.”
“I guess you’re not doing so well or you’d tell me you were fine and I would let you leave.”
“I don’t need much from you, just name, rank, and serial number.”
“Okay, how about them Yankees?”
The patient will usually respond to any of these lines, realizing you expected an answer. Don’t worry if the patient doesn’t laugh, because people who don’t say hello usually don’t laugh either, and people who are frightened may expectedly not respond. You can’t make everyone laugh; don’t take it personally. Many times the unresponsive patient is either frightened, in pain, or shy. By joking around, they will often warm up. The chapter on body language contains more on managing the unresponsive patient.
Patient Is Feeling Fine
Getting back to greeting the patient who is feeling fine:
“Good morning, and how are you doing today?”
“Fine? Then what are you doing here?”
Ninety percent of your patients are going to smile or laugh. This ninety percent now likes you, and if you keep up the routine they will love you by the time they are ready to leave.
The patient may respond to your initial greeting with:
“I’m fine doctor. How are you?”
Don’t let this variation on the theme throw you for a loop. It’s really quite simple, you say:
“I’m doing well, too.”
“If we’re both so good, what are we doing here?”
Variation after the pause:
“We’re both doing fine, it’s a nice day; let’s get out of this place.”
Bingo! They smile or laugh.
When the patient is fine, you have an opportunity to use another line that gets a great response. You now query them about things like symptoms and their current condition.
“Are you having any pain?”
“Well, I can fix that.”
You can use this line if the patient says they are fine as in the first example, too. This makes most patients laugh. If they don’t, just keep telling yourself it isn’t you, and you’ll be fine.
Pause just a bit after their chuckle, and proceed:
“As a matter of fact, that’s my specialty!”
You now own this patient. They will never leave you unless they find out you don’t accept their insurance.
Patient Is Feeling Bad
“So, how are you doing this fine afternoon?”
The patient may elaborate:
“I’m not doing so well. I was up all night in pain.”
From this response, the astute practitioner should immediately realize this patient needs their help, even if they don’t accept the patient’s insurance.
“Gee, I was hoping one of us was feeling okay.”
Variation for patient two:
“Then you’re in the right place. All day long, I see people who were up all night and most of them survive this experience.”
Assuming the patient isn’t in acute pain, they will smile. Don’t expect the laugh. If they are in true distress you will want to hold up on the humor, as it may seem unsympathetic.
Sometimes you encounter the SARCASTIC PATIENT:
“Good morning, and how are you today?”
“If I was that good, I wouldn’t be here.”
“Well, I’m doing great and I’m here. One of us must be in the wrong place.”
This line helps to disarm the sarcastic patient, and it let’s them see you have a sense of humor.
The Patient With A Companion
When you enter the treatment room and find a spouse or other adult friend accompanying the patient who is seated on the examination table or treatment chair, say:
“Good morning. How’s everyone doing today?”
You will get an answer from one or both of the parties. As long as they don’t burst into explaining why they are there (some patients and their guests impulsively want to tell you their story before you ask), you look at the visitor and say:
“I suppose you’re the patient and you talked Jim, here, into sitting in that chair, so you could find out what we’re going to do to you.”
Unless the couple doesn’t speak English or has no sense of humor, you get a laugh and begin your relationship on a friendly lighthearted note.
Don’t use the same greetings with all of your patients every time you see them. Sometimes you can just say, “That’s great,” when they say they are fine, or “We’re here to get you better,” if they tell you they are terrible. You can even make small talk: “It sure is a lovely day. What are we doing in a place like this with the sun shining so brightly?”
There are an unlimited number of responses you can use to provide comedic variation. The object is to show that you have a sense of humor and some personality, even if you don’t. It’s not so hard to practice greetings and see which ones work. After trial and error, you should come off as friendly and witty to most of your patients. Practice these greetings and you are on your way to having great bedside manner.