Bad Bedside Manner May Be Linked to Multitasking

JAMA article suggests physicians scrutinize themselves as much as patients

September 04, 1999

While multitasking - the ability to do several things at once - may be a great asset in the corporate world, it may diminish a doctor's ability to care for patients, suggests a University of Rochester physician in the latest issue of the Journal of the American Medical Association. Ronald Epstein, M.D., associate professor of Family Medicine and Psychiatry, says that impersonal doctors and those who overlook symptoms may have been taught in medical school to separate technical expertise from compassion.

"Seeing compassion and medical proficiency as separate entities means having to multitask to do both at once," explains Epstein. "Doctors end up juggling and eventually something is going to drop. What we need to teach our doctors is that compassion and expertise are part of the same thing: a competent doctor."

Epstein calls the anti-multitasking school of thought, "mindfulness." It's the ability to pay attention to the patient's words, their symptoms, the doctor's knowledge, intuition and state of mind - all as a single element. For example, separating the disease from the patient easily leads to a doctor calling a patient with an infected gallbladder, "the gallbladder in room 567." Likewise, separating the doctor's mindset from the patient's words could lead to alcoholic patients receiving poor care from a doctor who is a child of an alcoholic. A mindful doctor keeps tabs on herself and her behavior as much as on her patients'.

"There has been a lot of concern lately over the decline in professionalism of medical trainees," says Epstein. "Prior efforts, such as ethics and humanities courses, have failed to produce more caring doctors. Mindfulness can be modeled for medical students though good mentoring. There is even some recent evidence that students become more self-aware when in a small group that discusses physicians' emotions."

At the University of Rochester, students begin medical school by writing about their experiences as patients so they can appreciate both a patient's and a doctor's perspective. They are also encouraged to explore their own family and cultural backgrounds to understand themselves better as people, caregivers and developing professionals. Epstein points out that perhaps the most important element is good mentoring by exceptional physicians. The best physicians seem to have a capacity for critical self-reflection that pervades every aspect of their practice. They treat the patient like a person instead of a case, they keep a sense of curiosity so they stay observant, and they recognize and learn from their mistakes. A new curriculum at the University of Rochester will make extensive use of the mentoring abilities of the community's doctors.

"Musicians play their instruments, read the music and listen to how they are playing, yet few would call this multitasking," he says. "It's just playing the instrument. The ability to finger a violin's fretboard takes a technical knowledge while the ability to feel how moving the music is takes another kind of knowledge. Both are necessary to create a good musician. Likewise, doctors should consider all the aspects of their profession as a single task. It's just being a doctor."

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