Bedside manner to focus on patients, not tools and computers
The doctor knelt at the bedside to perform the time-honored tradition of percussing the heart. "Do it like this," he said, placing his left hand over the man's heart, and tapping its middle finger with the middle finger of his right.
One by one, each trainee took a turn. An X-ray or echocardiogram would do the job more accurately. But Dr. Heineken wanted the students to experience discovering an enlarged heart in a physical exam.
Dr. Heineken fills his teaching days with similar lessons, which can mean struggling upstream against a current of technology. Through his career, he has seen the advent of CT scans, ultrasounds, M.R.I.'s and countless new lab tests. He has watched peers turn their backs on patients while struggling with a new computer system, or rush patients through their appointments while forgetting the most fundamental tools -- their eyes and ears.
For these reasons, he makes a point of requiring something old-fashioned of his trainees.
"I tell them that their first reflex should be to look at the patient, not the computer," Dr. Heineken said. And he tells the team to return to each patient's bedside at day's end. "I say, 'Don't go to a computer; go back to the room, sit down and listen to them. And don't look like you're in a hurry.' "
One reason for this, Dr. Heineken said, is to adjust treatment recommendations based on the patient's own priorities. "Any difficult clinical decision is made easier after discussing it with the patient," he said.