Bedside Manner Research Articles

A natural language processing approach to uncover patterns among online ratings of otolaryngologists.

Patients increasingly use physician rating websites to evaluate and choose potential healthcare providers. A sentiment analysis and machine learning approach can uniquely analyse written prose to quantitatively describe patients' perspectives from interactions with their physicians. Online written reviews and star scores were analysed from Healthgrades.com using a natural language processing sentiment analysis package. Demographics of otolaryngologists were compared and a multivariable regression for individual words was performed. This study analysed 18 546 online reviews of 1240 otolaryngologists across the USA. Younger otolaryngologists (aged less than 40 years) had higher sentiment and star scores compared with older otolaryngologists (p < 0.001). Male otolaryngologists had higher sentiment and star scores compared with female otolaryngologists (p < 0.001). 'Confident', 'kind', 'recommend' and 'comfortable' were words associated with positive reviews (p < 0.001). Positive bedside manner was strongly reflected in better reviews, and younger age and male gender of the otolaryngologist were associated with better sentiment and star scores.

Understanding online ratings of joint arthroplasty surgeons: A national cross-sectional analysis

BackgroundPatient reviews provide an important referral source for physicians and an opportunity to improve practice performance. This study's objective was to characterize the online reviews of hip and knee arthroplasty surgeons published by three of the industry's leading platforms. MethodsA random sample of 1000 hip and knee arthroplasty surgeons across all 50 US states (10 hip and 10 knee surgeons per state) was generated using Google Search. A total of 7842 online reviews posted for those surgeons on Healthgrades, Vitals, and Google were analyzed. A range of surgeons, affiliated hospitals, and reviewer attributes was compared to identify significant predictors of patient satisfaction. ResultsThe study cohort had 98.1% male surgeons with a mean age of 53.55 ± 8.94 years and mean experience of 26.43 ± 9.21 years. Younger age (p < 0.001), shorter years of experience (p < 0.001), and arthroplasty fellowship training (p < 0.001) were associated with more positive ratings. Reviewer anonymity, observed in 30.93% of all reviews, tended to correlate with more negative ratings (p < 0.001). Overall, 86.93% of patient remarks were positive, and only 74.81% of remarks centered on physician attributes. The five leading components of patient satisfaction were perceptions of physician competence (34.81%, p < 0.001), bedside manner (23.83%, p = 0.002), and communication (16.17%, p = 0.94); interactions with physician extenders (14.75%, p < 0.001); and wait time (2.73%, p < 0.001). ConclusionWhile most ratings of hip and knee arthroplasty surgeons were positive, more than a quarter of reviews were either not directly related to the individual surgeons or were submitted anonymously. Caution is advised regarding overreliance on patient experience surveys as predictors of physician performance.

Do Patients Assess Physicians Differently in Video Visits as Compared with In-Person Visits? Insights from Text-Mining Online Physician Reviews.

Introduction: Use of both in-person and video visits have become a common norm in health care delivery, especially after the COVID-19 pandemic. It is imperative to understand how patients feel about their providers and their experiences during in-person and video visits. This study examines the important factors that patients use in their reviews and differences in the relative importance. Methods: We performed sentiment analysis and topic modeling on online physician reviews from April 2020 to April 2022. Our dataset comprised 34,824 reviews posted by patients after completing in-person or video visits. Results: Sentiment analysis yielded 27,507 (92.69%) positive and 2,168 (7.31%) negative reviews for in-person visits, and 4,610 (89.53%) positive and 539 (10.47%) negative reviews for video visits. Topic modeling identified seven factors patients used in their reviews: Bedside manners, Medical Expertise, Communication, Visit Environment, Scheduling and Follow-up, Wait times, and Costs and insurance. Patients who gave positive reviews after in-person consultations more frequently mentioned communication, office environment and staff, and bedside manners. Those who gave negative reviews after in-person visits mentioned longer wait times, providers' office and staff, medical expertise, and costs and insurance problems. Patients with positive reviews after video visits emphasized communication, bedside manners, and medical expertise. However, patients posting negative reviews after video visits frequently mentioned problems with appointment scheduling and follow-up, medical expertise, wait times, costs and insurance, and technical problems in video visits. Conclusions: This study identified key factors that influence patients' assessment of their providers in in-person and video visits. Paying attention to these factors can help improve the overall patient experience.

Smartphone Use During the Adolescent Visit.

As smartphone use in the office becomes more commonplace in medical practice, it is important to navigate this issue with grace, all while considering the legal, medical, and social implications, as well as the effect our behavior plays on our perceived bedside manner.

Master clinical teachers and personalised learning.

Clinical history taking and physical examination are two of the most important competencies of physicians. In addition to informing diagnoses, these activities build rapport and establish relationships between caregivers and patients. Despite this, emphasis on the assessment of bedside clinical skills is declining. To prepare our students for clinical work, we began a clinical competency, personalised teaching programme in which students perform a history and physical examination in front of a master clinical teacher (MCT) approximately every 2 weeks throughout their core clerkship year. The MCT works with the student in a clinical encounter, providing personalised bedside instruction on all features of being a clinician including bedside manner, history-taking skills, physical examination skills, and clinical reasoning. The MCT then provides an assessment of student's competency development and gives feedback to the student about what they do well and where they have opportunities for growth. Assessment data are collected and tracked longitudinally across the clerkship phase to ensure that each student is progressing developmentally. With over 6000 observations of student performance, we are able to discern competency development and growth over time. We can identify if a student is not improving as expected during their clerkship phase and intervene by providing extra practice and training. This core clerkship teaching programme has been well received by both students and instructors and has led us to pilot this approach during the post-clerkship phase of our medical training.

Characterizing Single-star Negative Online Reviews of Orthopaedic Trauma Association Members.

The purpose of this study was to characterize factors that contribute to 1-star negative reviews regarding orthopaedic trauma surgeons. A search was done for Orthopaedic Trauma Association members on Yelp.com , Healthgrade.com , and Vitals.com in New York, Boston, San Francisco, Los Angeles, Dallas, Phoenix, Seattle, Baltimore, Denver, Houston, Philadelphia, and Washington, DC. All single-star reviews (out of a possible 5 stars) were included in this study. Reviews were categorized as either clinical or nonclinical and then further subcategorized. Categorical variables were analyzed using a chi-square test. The rate ratio (the ratio of the rate for nonsurgical divided by surgical reviews) was determined for each category. Two hundred eighty-eight single-star reviews were included in the study, comprising 655 total complaints. Of all complaints, 274 (41.8%) were clinically related and 381 (58.2%) were nonclinical. Of the 288 single-star reviews, 96 (33.3%) were from surgically treated patients and 192 (66.7%) were from nonsurgical patients. Most complaints were in reference to nonclinical aspects of care such as physician bedside manner (173 reviews, 60%), not enough time spent with provider (58 reviews, 20%), and wait time (42 complaints, 15%). The most common clinical complaints were for complication (61 reviews, 21%), disagree with decision/plan (49 reviews, 17%), and uncontrolled pain (45 reviews, 16%). Surgical patients had a significantly higher rate of clinical complaints than nonsurgical patients (1.57 vs. 0.64 clinical complaints per review, P < 0.001). Nonsurgical patients had a significantly higher rate of nonclinical complaints than surgical patients (1.43 vs. 1.10 nonclinical complaints per review, P < 0.001). Most 1-star reviews referenced a nonclinical aspect of care with a physician's bedside manner being the most common complaint. Surgical patients were markedly more likely to reference a clinical aspect of care, such as complications or misdiagnosis compared with nonsurgical patients, who more commonly referenced nonclinical aspects of care.

A Novel Disability Advocacy and Awareness Program for Training Future Healthcare Professionals on Care for Patients with Disabilities.

In a poll of 714 US physicians, it was revealed that only 40.7% felt very confident in their ability to provide the same quality of care, overall, to patients with disabilities (PWDs) compared with patients without disabilities. It was also found that only 56.5% strongly agreed that they welcomed PWDs into their practice as healthcare providers. This suggests a systemic issue of inequity in medicine, which affects both physicians and patients. If this problem is not corrected, our healthcare system will continue to lack in providing adequate care to PWDs. A key component of this issue is that the lack of confident care for PWDs appears to be a result of insufficient exposure to PWDs during the formative years in medical schools. Although medical students are taught extensive clinical skills and bedside manners, there appears to be little mention of how to make adaptations to basic patient encounters to accommodate PWDs. Further, the lack of representation of PWDs in the medical community results in minimal experience among trainees and the perpetuation of unjust biases in the healthcare system. Changes to the medical field must start with shaping future physicians and filling the void in medical education. As a solution, we at Florida State University (FSU) College of Medicine (COM) propose a program called the Disability Advocacy and Awareness Program (DAAP). Two interactive sessions were designed, and students were offered an immersive experience in which they were not only provided with information through well-crafted presentations but also encouraged to engage in direct interactions with PWDs and a myriad of assistive devices. We believe a great deal of the program's success stemmed from the two-phase interactive model that allowed students to undergo a truly immersive experience that a textbook cannot endow. Although we cannot expect every provider to be an expert on all disabilities, all physicians should have an understanding of how a disability mayimpact a patient's life and medical care. Improved knowledge and awareness surrounding disability and the barriers faced by the PWD population will provide insights that will allow for the most equitable, patient-centered care for the disabled community.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Ralph L. Sacco, 65, Dies: Stroke Expert With a Talent for Architectural Design.

Bedside Manners and Artificial Intelligence

Bedside Manners and Artificial Intelligence

Patient Perspectives of the Hospital Discharge Process: A Qualitative Study.

Care transitions after hospitalization require communication across care teams, patients, and caregivers. As part of a quality improvement initiative, we conducted qualitative interviews with a diverse group of 53 patients who were recently discharged from a hospitalization within a safety net hospital to explore how patient preferences were included in the hospital discharge process and differences in the hospital discharge experience by race/ethnicity. Four themes emerged from participants regarding desired characteristics of interactions with the discharge team: (1) to feel heard, (2) inclusion in decision-making, (3) to be adequately prepared to care for themselves at home through bedside teaching, (4) and to have a clear and updated discharge timeline. Additionally, participants identified patient-level factors the discharge planning team should consider, including the social context, family involvement, health literacy, and linguistic barriers. Lastly, participants identified provider characteristics, such as a caring and empathetic bedside manner, that they found valuable in the discharge process. Our findings highlight the need for shared decision-making in the discharge planning process to improve both patient safety and satisfaction.

Analysis of Negative Reviews of Orthopedic Oncology Surgeons: An Investigation of Reviews from Healthgrades, Vitals, and Google.

Physician review websites (PRWs) are increasing in usage and popularity. Our purpose is to characterize one-star reviews of orthopedic oncology surgeons to understand factors in healthcare that contribute to patient satisfaction. Orthopedic oncology surgeons were randomly selected from the Musculoskeletal Tumor Society. A search for one-star reviews was performed on Google Reviews, Healthgrades, and Vitals.com. Reviews were classified as clinical or nonclinical. Statistical analyses were performed regarding the frequency of reviews and complaints for each category. Of the 7,733 reviews discovered, 908 (11.7%) were identified as one-star reviews. Of 907 usable complaints, 362 (40.8%) were clinical and 545 (59.2%) were nonclinical. The most common nonclinical complaints included bedside manner (65%) and limited time with providers (19%). The most common clinical complaints included complications (26%) and disagreements with the treatment plan (26%). There were 120 surgical and 221 nonsurgical reviews. Surgical patients had a higher rate of clinical complaints. Nonsurgical patients had a higher rate of total complaints. To the best of our knowledge, this is the first study examining PRWs regarding orthopedic oncology surgeons. Most one-star reviews were due to nonclinical complaints from nonsurgical patients. The most common factors are bedside manner, limited time with provider, phone communication issues, and rude/unprofessional conduct.

Prayer and Care: Faith as a Form of Culturally Competent Care.

As I walked into the examination room I saw my patient, an elderly Russian woman, lying on the stretcher, weeping. A young woman, her granddaughter, sat in a chair to the side, crying and repeatedly stroking her grandmother’s hand. All I had been told was that this patient needed a consult for a finger laceration. But the crying in that room spoke of something different than purely physical pain. Almost hesitant to discover what that was, I attained the history through the patient’s granddaughter, who translated fluently between Russian and English and stopped only to comfort her grandmother or to collect herself through her own tears. She told me that the older woman, Ms. S, had just seen her eldest son die by suicide. He had taken a knife with clear intentions and Ms. S, in desperation, had tried to grab the weapon from his hand. She was unable to stop him and suffered a sizeable laceration in the process. The granddaughter was home at the time and had watched all this happen. By this point in medical school I had developed (what I considered to be) basic competencies in both suturing and bedside manner. But I felt completely helpless after listening to this story. I could try and repair Ms. S’s laceration but I could never restore what she had lost, and even hope seemed tenuous. Not long after the granddaughter finished relaying the history, a middle-aged man entered the room. He was the youngest son of Ms. S. He bent down to hug his mother on the emergency stretcher, and almost immediately—and in complete sincerity—he reminded her of their Christian faith, their held promise that things would be well. He shared hope for peace and healing for his older brother after so much torment, and Ms. S, soaked in grief, smiled and then cried. After a long silence, I looked at her son and told him that I admired his faith. He looked at me and asked if I was a Christian. I nodded and showed him a tattoo of a cross on my right wrist. He smiled and asked if we—all of us—could pray together. I said yes, and after the prayer and a brief physical examination of Ms. S, the son hugged me and thanked me for my care. I am aware of the complexities and divisions within religious life in America. When I was a medical student, I tried to be thoughtful and professional about where and how I mentioned my faith, and the same is true for me now as a resident in orthopedic surgery. My goal is to provide the best, most inclusive and culturally competent care for my patients, regardless of age, sex, race, or belief. For that reason, faith is not something I talk about often at work. But neither is it something I can ignore. Not because it is my faith, but precisely since it is not solely mine; because it forms the core of so many of my patients’ lives. Faith is relevant to the clinical interaction when it gives patients and clinicians a shared ground upon which to stand in the midst of chaos, and my experience with Ms. S showed me that spirituality can effect healing when all else fails. It is not, of course, incumbent on any individual clinician to offer that healing. But I believe that a selfless prayer or caring affirmation may have its place for those who find themselves able, in good faith, to share it with patients.

Gravida Plus One

Gravida Plus One Anita Kumar Chang The moment I found out I was pregnant was also the moment I realized I was likely having a miscarriage. A week after that first pregnancy test, I found myself lying on an exam table at the obstetrician's office, undergoing an ultrasound to try to confirm the pregnancy or lack thereof. I lay quietly as the doctor pushed the probe around, searching and searching. I watched my husband's face as he watched the ultrasound screen, knowing that he, an emergency medicine physician, would understand what was happening before the OB told me. I could see concern, but I couldn't decipher more than that. I waited. After what seemed like an hour, the doctor told me, matter-of-factly, "yeah, there are no products of conception in the uterus," then turned and walked out of the room. I was stunned into silence. How could this be the way I found out? It was shocking and anti-climactic at the same time. As a physician myself, I was acutely aware of the lack of bedside manner and the lack of humanity he showed me. This may be a routine result for him, and he was certainly acting like it, but for me, a person who'd been trying to conceive for years, it was shattering. I don't think I started to cry until we reached the car. My husband and I sat there in silence as I wept. He was in his usual mode for dealing with bad news, denial. From the moment I took the pregnancy test until now, he hadn't had much hope, so he had prepared himself against being disappointed. I had known from the first spotting that my chances were 50/50 of miscarrying. But I like to read into things. I had calculated from my last menstrual when I must have conceived and realized it was on our wedding anniversary. It felt like a sign that this was meant to be and it was going to work out in the end. I had just moved to a new town to start my first job since finishing training. With all the "new," a new life coming into the world seemed to make sense. Yet, it wasn't happening. The stress didn't end there. The day before I flew to Savannah for my girlfriend's bachelorette party weekend, I had to have my blood drawn to track the pregnancy hormone to make sure it was trending downward appropriately. As I was waiting for my luggage in baggage claim, I got a call from the OB's office. My lab results had come back and it wasn't looking good. They wanted me to go directly to the nearest emergency department to make sure I wasn't having an ectopic pregnancy, a potentially life-threatening condition. Now in crisis-mode, my friends at my side, I went to the nearest ED and checked in. Part of the workup was another ultrasound, this time done by a technician [End Page E7] in the radiology department. While transport had wheeled me to the ultrasound room, no one was there to pick me up after the test. I waited in a wheelchair in the hallway for a while. Then the ultrasound tech, noticing that I was still waiting, gave me a pat on my back and with kindness, wheeled me back to the ED. It's strange how, at times like this, the smallest show of compassion makes its way deep into one's memory. The results came back, it wasn't ectopic, and I passed the products of conception. Back in my new hometown, the next week, I went to see the midwife I was originally scheduled to see for my first pregnancy appointment. I felt my face flush as I filled out the forms in the waiting room. What surprised, disturbed, and upset me, was the realization that I would forever be marked in OB notation as having had a miscarriage. In medical school, we learn about how to introduce a patient's obstetric history. The most basic part is the 'gravida para' numbers; gravida for the number of...

What's Important: Be That Doctor.

What's Important: Be That Doctor.

Analysis of Patients' Online Reviews of Orthopaedic Surgeons.

Introduction:Physician rating websites (PRWs) are an increasingly popular interface between patient and surgeon. Despite the growing popularity of PRWs, little guidance exists for orthopaedic surgeons regarding online reviews. We analyzed online ratings and comments to provide a better understanding of patients' values and expectations so that surgeons can tailor their practice accordingly to enhance their clinical care and online reputation.Methods:Three common PRWs (Vitals, HealthGrades, and RateMDs) were queried from January 1, 2006, to May 18, 2020. Publicly available ratings, both quantitative (1 to 5 stars) and qualitative (free text comments), were collected. Comments were qualitatively tabulated as having positive or negative assessments for categories including outcome, personality, staff, surgical skill, visit time, bedside manner, wait time, diagnosis, knowledge, treatment, and advanced practice providers and analyzed using chi square goodness of fit. Quantitative comparisons of star ratings were made across surgeon years in practice, sex, practice setting, and PRW and compared using chi square independence testing.Results:In total, 81% of patient comments were found to have a positive assessment. Comments regarding outcome (P < 0.001), staff (P = 0.001), surgical skill (P < 0.001), or knowledge (P = 0.001) were more likely to be positive. Reviews regarding bedside manner (P < 0.001), wait time (P < 0.001), diagnosis (P < 0.001), treatment (P < 0.001), or advanced practice providers (P < 0.001) were more likely to be negative. Surgeon sex was not associated with a difference in quantitative ratings (P = 0.131), unlike practice setting (P < 0.001) and PRW (P < 0.001).Discussion:PRWs are a growing interface between surgeon and patient with a considerable effect on surgeon marketability. This study reveals a statistical association between certain patient-centered medical practices and positive patient reviews. This emphasizes the importance of ensuring that high standards are maintained throughout a physician's practice of maintaining a constant awareness of the fundamentals for effective patient care and of taking care to curate a physician's online presence.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study.

BackgroundAlthough videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses’ ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey.ObjectiveThis study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs).MethodsIn this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis.ResultsMost patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present.ConclusionsPerson-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines.International Registered Report Identifier (IRRID)RR2-10.2196/27940

HRSA's Investment in Public Health Training Centers.

HRSA's Investment in Public Health Training Centers.

Sentiment Analysis of Online Patient-Written Reviews of Vascular Surgeons

Online patient reviews influence a patient's choice of a vascular surgeon. The aim of this study is to examine underlying factors that contribute to positive and negative patient reviews by leveraging sentiment analysis and machine learning methods. The Society of Vascular Surgeons publicly accessible member directory was queried and cross-referenced with a popular patient-maintained physician review website, healthgrades.com. Sentiment analysis and machine learning methods were used to analyze several parameters. Demographics (gender, age, and state of practice), star rating (of 5 stars), and written reviews were obtained for corresponding vascular surgeons. A sentiment analysis model was applied to patient-written reviews and validated against the star ratings. Student's t-test or one-way analysis of variance assessed demographic relationships with reviews. Word frequency assessments and multivariable logistic regression analyses were conducted to identify common and determinative components of written reviews. A total of 1,799 vascular surgeons had public profiles with reviews. Female gender of surgeon was associated with lower star ratings (male=4.19, female=3.95, P<0.01) and average sentiment score (male=0.50, female=0.40, P<0.01). Younger physician age was associated with higher star rating (P=0.02) but not average sentiment score (P=0.12). In the Best reviews, the most commonly used one-words were Care (N=999), Caring (N=767), and Kind (N=479), while the most commonly used two-word pairs were Saved/Life (N=189), Feel/Comfortable (N=106), and Kind/Caring (N=104). For the Worst reviews, the most commonly used one-words were Pain (N=254) and Rude (N=148), while the most commonly used two-word pairs were No/One (N=27), Waste/Time (N=25), and Severe/Pain (N=18). In a multiple logistic regression, satisfactory reviews were associated with words such as Confident (odds ratio [OR]=8.93), Pain-free (OR=4.72), Listens (OR=2.55), and Bedside Manner (OR=1.70), while unsatisfactory reviews were associated with words such as Rude (OR=0.01), Arrogant (OR=0.09), Infection (OR=0.20), and Wait (OR=0.48). Female surgeons received significantly worse reviews and younger surgeons tended to receive better reviews. The positivity and negativity of reviews were largely related to words associated with the patient-doctor experience and pain. Vascular surgeons should focus on these 2 areas to improve patient experiences and their own reviews.

Reevaluating Gendered Language in Surgery.

Reevaluating Gendered Language in Surgery.