Morning Rounds: Modern Medicine Faces Challenge of Keeping Patients Safe While Maintaining Patient — Physician Relationship
To Your Health —
Thursday, May 19, 2016 12:42 PM
One thing I have become pretty committed to in my practice of emergency medicine is shaking hands when I walk into an exam room.
Mark Fourre, MD, is an emergency physician and Chief Medical Officer of LincolnHealth. He also serves on their Board of Trustees. Prior to joining Lincoln- Health, Dr. Fourre was an attending faculty physician at Maine Medical Center where he developed the Emergency Medicine Residency Program and served as Residency Director.
Shaking hands is an important gesture in our culture and it has been shown to promote cooperation and good communication, which is important when you are meeting people for the first time and may have to ask them fairly intimate questions or examine them in sometimes invasive ways.
But here is another thing about touch: it is a great way to spread infections, and in the age of antibiotic-resistant bacteria, it’s not worth gaining a patient’s trust if we are endangering their lives in the process.
So I have developed a routine that I follow every time I go into an exam room to meet a patient. First, I use foam or gel to disinfect my hands (there is usually a dispenser just outside the door). Then, while rubbing my hands together in plain view, I introduce myself and shake hands while my hands are nearly dry, again confirming that they have been disinfected.
This ritual helps me establish a therapeutic relationship by showing my patient and their family members that I am concerned for their safety. It also helps establish a more human connection through a form of touch that is not only culturally understood in positive ways, but has even been shown to help build trust and cooperation on a neurological level.
With the right connection, it is much easier to gain the information, both verbal and nonverbal, that leads to the right diagnosis and effective treatment. Without it, nothing goes smoothly.
Shaking hands has been part of my routine long enough that I don’t give it a second thought, but something happened the other day to remind me just how important a simple handshake can be.
I was taking part in LincolnHealth’s Operational Excellence, a program based on lean management principles designed to better engage front-line employees in solving problems and improving quality.
As part of Operational Excellence, top leadership and managers visit each department every morning and listen to employees explain the goals they have established and the data they have generated to help reach those goals. Part of this process involves a group introduction in which everybody verbally introduces themselves in turn.
I was at Cove’s Edge, our long-term care and rehabilitation facility, waiting for the group to form and looking over the data on display when a woman named Lisa walked up to me and shook my hand. As the group came together, she repeated the process, shaking everyone’s hand in turn.
I can’t honestly tell you whether Lisa is a therapist, a nurse or a Certified Nursing Assistant, but I will definitely recognize her when I see her again, and I will remember how connected I felt to her.
Something about that handshake totally changed the dynamic of what can be a somewhat awkward process. I felt much more connected not only to Lisa but to everyone else there that morning.
That experience reminded me how important touch can be on a simple human level. Done properly — and understanding a patient’s culture is very important — touch breaks down barriers and builds trust.
Negotiating the tension between doing the simple things that help us build real human connections with our patients while making sure we use the practices that research has proven keep them safe is one of the real challenges of modern medicine.
A great example of this is the use of electronic medical records. Electronic medical records allow doctors to avoid medical errors by ensuring that everyone who treats a patient has access to that patient’s complete medical record when they need it.
As an emergency physician, I know that when a patient arrives in a MaineHealth Emergency Department with serious health conditions — a heart condition or diabetes for example — having all of his or her information, including their potentially lengthy list of medications, is vital to providing good care.
At the same time, many doctors have a strong antipathy toward electronic medical records because they find they are spending far too few of the precious minutes they have with patients typing away on computers and populating data fields in electronic medical records.
Between sometimes intrusive technologies and the busy nature of modern medical practices, doctors who got into medicine for all the right reasons are finding their jobs are no longer satisfying. Patients sometimes feel as though they no longer have a relationship with their doctors.
We know we have to do better. We know the patient-provider relationship is vital to helping patients make good long-term decisions about their health, such as eating better, exercising more or stopping smoking. At the same time, we know technology like electronic medical records is essential to saving lives by preventing medical errors.
The question is how to use technology without allowing it to come between the patient and the physician. For the moment, it is a question without a complete answer, but we are working on that every single day.