3. It Highlights Diagnostic Decision Making
Even tougher than teaching the clinical exam is highlighting diagnostic decision making. In large part, this is because sound decision making demands incorporation of several compression inputs in order to reach an assessment and plan. Many inputs are subtle—maybe the feel of bogginess in the hands leaves a distinct impression, for example, compared to simply hearing a patient has second MCP swelling. Maybe a hint of hesitation in a patient’s voice will open a conversation about adverse effects and therapy modification. By moving the diagnostic reasoning setting to the patient’s room, then, these inputs can occur true to form. In the right context, the teacher can even probe how a learner is synthesizing information and make valuable suggestions to improve their method of putting signs and symptoms together.
4. It’s Billable
One nuance of billing and coding is that if you’re billing by time, the attending must be present, and more than 50% of the encounter must be devoted to the counseling and coordination of care. Sadly, resident and fellow time doesn’t count. Therefore, if a patient requires a lot of education (such as for fibromyalgia) and requires medically necessary laboratory or radiographic workup, it may prove far more productive to sit in the room and receive credit for what you intend to do anyway. And at the same time, if the attending is actively engaged, it allows opportunities for quiet observation and feedback.
5. It Provides Opportunities for Observation
Perhaps the most valuable aspect of bedside teaching is that it provides opportunities to not only increase the amount of observation time, but also improve the quality of observation. Indeed, the art of observation is more than just passive action; it’s a clinical skill that’s vital for educators. The more you observe, the more you can observe.
On quiet days, I sometimes sit through an entire interview between learner and patient. I take a piece of paper and write down my thoughts and observations like an impassionate fly on the wall. These notes become the basis for later feedback, making it structured and objective.
In contrast, on busier days, I sometimes work as the scribe and type the current illness history as the learner talks, helping me maximize my productivity both inside and outside the clinic. And I can learn, too, by picking up on habits my learners have acquired and cultivated from other sources.
