The physical examination, when used as a framework for discovering clinical clues, encourages taking notice of how the patient shows signs of their illness. When done with the proper technique, some exams can help predict a diagnosis, reducing reliance on technology.The clinical encounter is wherever patients and providers come together to solve a medical problem or improve a patient’s health. This interaction most commonly takes place at the bedside.

Increased workload, clerical demands, high-patient volumes and staffing issues can limit doctors’ and attending physicians’ availability to fully engage and prioritize connectivity with patients. These can lead to gaps in care and understanding of patients’ ever-changing medical circumstances. The accuracy of diagnoses, precision of specialized care and decline in doctor-patient trust is directly impacted.

In a review published in the New England Journal of Medicine, researchers from the University of Alabama at Birmingham and Northwestern University developed six strategies to improve bedside clinical skills. These practices can be implemented to cultivate better patient relationships, while decreasing negative patient outcomes and experiences.

“From an educational standpoint, the best way to learn about patients is to be with them,” said Stephen Russell, M.D., a physician and professor in the UAB Division of General Internal Medicine and Population Science. “Each of these six steps was crafted under the mindset of finding ways to get doctors out of the conference room and hallways and back to the bedsides where their patients are located.”

Be present at the bedside 

• Time spent in the presence of the patients can reveal important details and developments about their condition.

Embrace an evidence-based approach to the physical exam 

• The physical examination, when used as a framework for discovering clinical clues, encourages taking notice of how the patient shows signs of their illness. When done with the proper technique, some exams can help predict a diagnosis, reducing reliance on technology.
• “An appropriate physical exam can help avoid the need for additional diagnostic testing, yet research has shown the most commonly reported error in the physical exam is simply that the exam was never performed,” said Northwestern University Feinberg School of Medicine’s inaugural director of the Center of Bedside Medicine, Brian Garibaldi M.D., a nationally recognized expert in bedside teaching.

Create opportunities for intentional practice

• As with any skill, intentional practice improves performance. When providers are with patients during the clinical encounter, either in the hospital or in the clinic, they can learn how to discover clues that help improve diagnosis, management and communication.

Utilize technology

• Technology can be useful in providing context and clarity for specific cases. While digital tools or AI solutions might be viewed as a means to replace human touch, technology should be used to inform and augment human decisions at the bedside.

Seek and provide feedback on clinical skills

• Clinical skills do have best practices. There is value in giving real-time feedback to students and learners in front of patients. This feedback helps to improve the techniques of skills and demonstrate their usefulness.  

Recognize the value of being present beyond the evidence

• It is important to recognize and prioritize the power of being present with patients. A patient’s feeling seen and heard builds trust between the patient and provider. Skill without the human component does not ensure adequate care. 

Russell says modern medical education does a really good job of equipping trainees with the essential technical skills and scientific knowledge needed to effectively practice medicine. However, it is important to build upon the skills needed to build interpersonal relationships between a patient and doctor because that is where trust and reliability are established.

“What we are trying to do is buttress and reinforce the necessary skills of simple human understanding,” Russell said. “It is expected for a patient to believe their doctor is going to have the medical knowledge and technical skills to take care of them, but we must also recognize the value patients place in being cared for by being understood as a person along with understanding their illness.”

Human understanding is fundamental to effective clinical care. Integration of these strategies can work to strengthen the bond between doctors and patients while increasing the care provided at any hospital or medical institution.

“We hope these six steps are relatively easy to integrate in the clinical setting,” Russell said. “For example, open discussions of patient concerns and potential plans of care taking place in the presence of the patient is one way these strategies can easily be integrated.”

Russell says sharing and looking at images and numbers with the patients so they can directly see how these things are impacting and shaping the plan of care is another method of implementation.

These six steps were designed to be integrated at any degree of medical practice or education.

“The clinical encounter is a partnership between the patient and provider,” Russell said. “The most effective way to make that partnership productive is to ensure that time is spent listening and responding, which can only be done in the presence of one another.”