The concept of bedside manner is a complex array of impressions, previously held beliefs, practitioner behavior and situational components.

One thing that really impacts bedside manner, in my opinion, is the underlying personalities of the patient and the doctor. Some personalities gravitate to the "results oriented" approach where other personalities are more interaction driven. If you have a doctor and patient with a match on this, you will likely have a higher score of patient satisfaction. Likewise, if for instance the doctor is results driven where the patient is relationship driven, you may have a high mismatch and therefore higher dissatisfaction.

That being said, I believe that all people feel more comfortable with a doctor who exhibits caring in their manner and many studies have documented that if the patient feels their doctor cares they will not sue, even in light of human error. In my personal opinion, I think the skills of medicine can be learned if properly taught but the skill of caring is more difficult.

In my dealings with thousands of doctors, I strongly believe that cirriculum in medical school showing doctors how to exhibit their caring towards patients and the human condition, along with a more realisitic appraisal of their own personality traits would greatly improve medicine. Both the doctor patient interactions and the doctor/doctor and doctor/administration, etc would be improved.

I don't think bedside manner can be "faked" outside of the normal behaviors humans do to be civil with one another. The reason is, that non-verbal communication is estimated to be 93% of what goes on with humans and the other 7% is verbal. The doctor can try to fake it but will likely fail due to an underestimation of the impact of their body language. I do think that patients understand doctors don't have to LOVE every patient to be a good doctor and their are leniancies for this, but patients get really frustrated when they don't feel heard. The best thing a doctor can do to improve bedside communication is to ask good questions and really listen to the answer. Unfortunately, with 5 and 10 minute visits, this can be hard to do properly.

For more about the "kinds" of doctors (engineer, priest, colleague or one simply following a contract with the patient) a patient might find most comforting, review the discussion about this topic on Medpedia Questions: http://www.medpedia.com/questions/1701-what-kind-of-a-doctor-would-you-select-to-be-your-doctor-as-an-engineer-as-a-priest-as-a-colleague-or-as-a-doctor-simply-following-a-mutual-contract . Beth, it would seem that your doctors were behaving in these instances as a "colleague or friend" and this behavior impressed you. You know, Dr. Robert Veatch, a well-respected ethicist, has written that patients should get to know their physician's background, philosophy and religion to see if it matches theirs before selecting that physician for their doctor. There is something important in the relationship-to-be if there is some matching of views beforehand. Whether this approach to selection is practical in these current times for the practice of medicine can be debated. ..Maurice.

Kim, with regard to "counseling" end-of-life matters, obviously reimbursement for the time spent is an important factor but I am not sure that is the only issue that leads to physicians missing that current obligation to their patients. That obligation has really only been present in recent decades as it became clear that medical progress has permitted the situation of "prolonged dying". And it only has been in recent decades that the law has permitted patients to have the opportunity to reject life support and to terminate life support. To facilitate the decision of whether the physician should order such actions particularly when the patient has no capacity at that time to decide and speak that decision, it has become necessary to talk about those things before the last days when the patient is healthy or in stable medical condition. There is a psychological barrier for the physician to initiate such discussion. There are several reasons for this. Most doctors haven't been trained to perform this activity or to be aware of all the end-of-life options available through the relatively new specialty of palliative care. For various reasons, hopefully not entirely self-interest, doctors are not inclined to deny medically appropriate care to preserve life. Perhaps they are concerned they may be, in the eyes of the patient and family, failing in their life preserving duties or failing to do "everything possible" to be free of false accusations of malpractice. In addition, currently from society's point of view, the unfair and unrealistic popular expression of such consultations as part of "death panels" can diminish the physician's interest in such counseling.

While counseling end-of-life issues should be part of the "bed-side" behavior of all physicians, it may require compensation for their time spent but also further education of the physicians and obviously also of society. ..Maurice.

Kim, continuing with what you suggested in your commentary, the paucity of discussions of end-of-life management desires with the patient may not be all the fault of the doctor but, as you imply with what you wrote,the resistance of the patients to accept the initiation of such a discussion. As I already suggested what constitutes the "beside manner" of the physician whether acted or not is really also dependent on the "manner" of the patient. It is about how the patient accepts the physician's views, advice, personality and the way of responding which I think sets the manner of the physician. If you think I am putting too much of a burden on the patient for the "bedside manner" responsibility, let me know. ..Maurice.

"I feel confident that physicians will use compassion and the caring 'bedside manner' to share end of life conversations with patients who want that, regardless of compensation"
I agree. After all, the doctor-patient consultation should never be looked at or financed as only
dealing with the physical body.. there is more to a patient than that. ...Maurice.