Melanie Cole (Host): Welcome to UAB Med.
I'm Melanie Co.
And today we're offering providers the important six steps to
improve bedside patient care.
Joining me is Dr.
Steven Russell.
He's an internal medicine physician at UAB Medicine and Co-President
of the Society of Bedside.
Dr.
Russell, I'm so glad to have you with us today.
What a great topic this is.
It's important, and it's one that can sometimes be overlooked in this day of
frenetic electronic medical records, spending certain amount of time your
patient's listing, you know, I mean, there's so much that goes on in the
hospital.
Dr Stephen Russell: Melanie, thanks for having me.
Yeah, what a great opportunity and I appreciate you asking
us to be a part of this.
So this is a article that came out last month in November, 2025 with a colleague
of mine from Northwestern named Dr.
Brian Garibaldi.
And for the last 10 years we have been part of a process of trying to
study and understand and improve.
The experiences that patients and physicians and students
all have at the bedside.
And so this article is the end result of a lot of previous work that had come
to that and hopefully a start of some of new activities that we can do in the
future.
Melanie Cole (Host): So tell us about some of the limitations that we started
to mention in the intro there that doctors and attending physicians have to fully
engage and prioritize their connectivity.
Speak a little bit about the scope of the issue.
We're talking
here today.
Dr Stephen Russell: Yeah, it's a great question and I think it's an important
place to start because we know that in the first 25 years of the 21st
century, there have been tremendous.
Benefits with technology that has come into the clinical encounter,
and we define the clinical encounter as any time a patient and
a provider are in the same room.
And in the context of this medical education has a learner, be it a
student or a resident in there as well.
But we know as all of these advances have taken place in the diagnosis and
treatment of certain conditions, there's also been some drawbacks in terms of
administrative responsibilities with the electronic health record, but also a
lack of time that patients and providers are spending together at the bedside.
And so one of the things that's been documented in previous studies is that
physicians are not quite as comfortable.
Interacting with and teaching in the presence of patients just because
of some of those limitations, and this article is a response to that.
Melanie Cole (Host): Then give us a quick overview of what those six steps
to improve bedside patient care, the framework is, and why it's become such
a focus for you personally, doctor.
Dr Stephen Russell: absolutely.
So it starts with what might seem to be easy and almost second nature
for some, but the very first.
Part of this, six part step is to just be present with patients.
We use the term bedside.
It has a lot of historical connotations, but of course this can be in the
hospital at the patient's bedside, or it can be in the outpatient
setting in a clinical space.
But the first step is just going and being present with patients.
We know from a learning standpoint that there's so much that we can see and learn.
Point out and observe just by being in the presence of the patient.
But what's equally important, if not more important, is there's so much that the
patients can teach us about what they're experiencing through their illness,
and ways that we can identify certain signs on their exam that might help us
understand that a little bit better.
Melanie Cole (Host): What are some of the gaps and challenges in that bedside
care that you were just discussing?
I mentioned a few earlier, but I mean, what are some of those
challenges you doctors face?
Dr Stephen Russell: Right now medicine is so fragmented.
We go into an educational space and we know that there are pagers
or notifications that come on people's phones that are critically
important for addressing some of the needs, perhaps of other patients
or responding to emergencies.
But in that fragmentation, we lose a continuity with patients.
And so part of this is bringing people together not to necessarily.
Change what they're doing, but to enhance what they're already doing when
they're communicating with patients.
So gap number one is just the fragmentation and gap number two is
actually a decrease in confidence.
Studies have been looked at to see that those who have finished
their original training in the two thousands may not be as comfortable.
Teaching some of these fundamental skills because they themselves didn't learn it.
So part of the aspect of this article that we also wanna emphasize is that
there are some fundamental skills that we can teach and share with our learners so
that when they're together with patients, they have an opportunity not only to
practice them, but to see their utility in both the diagnosis, but also in the
treatment of different patient concerns.
Melanie Cole (Host): Well, tell us some of those skills.
What have you learned about communication techniques that you are now taking
forward and teaching to other providers?
Dr Stephen Russell: Well, I think the first thing that I've
learned in doing this work is it is normal to be uncomfortable in
an environment where some of the information is not readily available.
We're very comfortable with looking at labs on a computer.
We're quite comfortable with ordering and interpreting tests, but the
patient has so much to share with us, both in terms of their experiences
with the illness, but also the ways in which illness presents itself.
And so one of the aspects of this article that we want to talk about is that it's
important to be present with patients even in the setting, where some of that
may be unfamiliar or uncomfortable.
But in doing that, we also know that a lot of these tests that we do at
the bedside, be it listening to a chest or feeling an abnormal joint
where there may be arthritis, there are certain physical signs that are
actually telling us what's going on.
A colleague of ours actually.
Likens this to the patient is a textbook and it's up to us to learn how
to read and interpret that textbook.
And if we get comfortable with this and spend enough time with it, then
the likelihood is, is that our fluency in the physical exam and the clinical
encounter will improve as well.
Melanie Cole (Host): Agreed.
That's so interesting and really so important.
Now when it comes to bedside care, Dr.
Russell, what does truly effective multidisciplinary
teamwork look like in practice?
Because how do you break down silos between nursing, physicians,
hospitalists, now, rehab, social work, and the ancillary staff that
create this unified care moment at the bedside and even in clinical practice?
Dr Stephen Russell: one of the best ways to have this multidisciplinary
care team work together is to reframe the focus, to realize that the patient
is actually at the center of the diagnostic and therapeutic process.
And in many ways, the patient is part of that care team.
So I think as we focus our attention on not only what patients are
sharing with us, but how we can help them on their healthcare journey.
We soon realized that each of the aspects of the medical team, be it
the learners, be it the teachers, the nurses, the therapist, and everyone in
between, is all working towards a similar goal, which is trying to improve that
patient experience, but also trying to improve the patient care as well.
And of course, as part of a medical, educational aspect, we wanna make
sure that as we move forward, these skills that we are teaching are soon
able to be taught by the learners to their learners down the road.
Melanie Cole (Host): That certainly is a great goal.
Now, what about some strategies that have had meaningful, improved patient
safety at the bedside falls, medication errors, hygiene, device management.
How does that all work into this bedside patient care?
Dr Stephen Russell: So one of the, points that we have in the
six point process is to use and leverage technology at the bedside.
So to the issue when it comes to safety, when it comes to
technology at the bedside.
We don't see this as a tug of war.
We don't see this as an either or.
We actually see that technology helps to compliment what
we're doing at the bedside.
We don't often think about this anymore, but 200 years ago, a
stethoscope was novel technology of how we understood patient illnesses.
Now we have things such as point of care, ultra sonography and wearable
devices that patients may bring to us, but those are also telling an
important part of the story as well.
So rather than saying that it's either the modern technology or
the antiquated time at the bedside.
We actually see that it's an integrated part, and that's the foundation of
21st Century Medicine is being able to combine what we can offer from a
diagnostic standpoint with what patients can offer from their experience.
Melanie Cole (Host): Well, so along those lines, Dr.
Russell, how do you teach or reinforce empathy in bedside interactions,
especially for early career clinicians who are navigating time pressures,
burnout for older clinicians?
I mean, how do you teach empathy and understanding?
'cause that's something that I feel sometimes is innate.
We have it or we don't.
Is there a way to teach that so that it becomes part of these six steps?
Dr Stephen Russell: Well, you bring up an important point, which is
that we're not asking for certain people with certain personality
characteristics to be learning these.
We realize that these are teachable skills and if we have an opportunity to help.
Formalize these to help enumerate these and then to help teach
these, it can make it a lot easier.
But I think the fundamental point to your question is that learning
empathy is learning to listen.
And the best way to do that is to be in the room at the bedside with the
patient as they tell their stories, as they share their experiences.
And sometimes those are uncomfortable experiences to hear.
Perhaps where the medical system has not served them well, perhaps where in
our haste and hurry we've overlooked things that are critically important.
When we go back to see, they're actually obvious when we take a moment to look.
That can only be learned when you're with the patient, when you're open to
the uncertainty that can be there, but also when you realize that you have
the same goal, which is partnering to try and understand how we can
improve their experience of illness.
Melanie Cole (Host): You mentioned at the beginning, Dr.
Russell, the partnership with Northwestern Medicine and Dr.
Garibaldi.
How did this come about?
How are you collaborating?
Are you co-developing training programs, joint research,
aligning bedside care models?
Tell us a little bit about this collaboration.
Dr Stephen Russell: So Dr.
Garibaldi and I met about 11 years ago also at a conference for bedside medicine.
This one at Stanford University.
And through that initial meeting, we realized that we had shared
interest in shared opportunities in an academic medical setting.
And so for the last 10 years, we have collaborated both with writing
projects leading up to this one, but also with organizations such as the
Society of Bedside Medicine, which is designed to create a culture of
bedside medicine, a culture of people that learn and teach at the bedside.
But also it was a way to be able to study this to find out what
are some of the best practices and to grow this community as well.
Just recently, Northwestern hosted its first Center for Bedside
Medicine conference, and probably the most important takeaway from
that conference is there's a hunger.
Among learners as well as educators to improve upon these skills.
And when folks get together, we can build that community work together and
find ways that we can really improve these skills that I think many people
are interested in knowing more about, but also interested in practicing.
Melanie Cole (Host): I certainly am.
And as an exercise physiologist, I understand the need for that time that you
take with the patients, the understanding that you take with the patients.
Dr.
Russell, are you seeing any early results or signals from this
partnership in terms of bedside care, quality, patient satisfaction?
What have you learned?
Dr Stephen Russell: We are actually seeing a good bit of results.
Many years ago, the Society of Bedside Medicine was able to join
with several academic medical centers across the country as part of an
American Medical Association Grant.
Called re-Imagining Residency, and this grant just finished up this year.
The study information is still being digested and sorted through, but one
of the early signals that we're seeing through this is that the more time people
spend with patients, people being medical learners, as well as teachers, the more
comfort they have with those skills.
But what we are starting to see is a decrease in burnout because the
majority of us went into medicine.
For patient care.
We went in for the service aspect of this job, but so much of what we do in typical
training seems to take us away from that.
So what the hope of this original grant was, and what we're starting to see is
that as people do spend more time with patients, they get more comfortable
with those skills, and as they get more comfortable with those skills, they feel
the ability to communicate with patients better and hopefully to improve their
own wellness in a professional space.
Melanie Cole (Host): I love the way you just said that.
What a great initiative this is.
It's so important as we forget in medicine, Dr.
Russell, that.
These are the kinds of things that you, as you said, so perfectly went
into medicine for, and so that's just something that reinforces that,
and sometimes it's easily forgotten.
As we wrap up, if you could wave a magic wand, what additional
resources or structural changes would most accelerate this progress?
Looking ahead, Dr.
Russell, what do you think bedside care might look like?
What would you like it to look like?
Dr Stephen Russell: I think that the most effective way that bedside care
can be carried out is when doctors and providers come together to share a mutual.
Agenda to understand the factors that have led to their current health conditions,
and then chart a course moving forward for improved health and better wellness.
At our home institution at the University of Alabama at
Birmingham, one of our early.
Ancestors, as it were from a medical standpoint, talked about
how important it was that physicians have scientific skill, technical
knowledge, and human understanding.
And as we think about 21st medicine, we do a really good job in medical
education of providing people a.
With that scientific knowledge, providing people with that technical skill.
What we hope that this article can build upon is the idea of standardizing
human understanding, allowing people to be in environments where that
human understanding can improve, and ultimately having a situation where,
when my turn comes to be in the patient's chair, I'm getting the same
level of care that I would want for myself and my family members, as well
as the same level of care that we're trying to share in medical education.
Melanie Cole (Host): Beautifully said, and I can hear the compassion and
the passion for what you're doing.
Dr.
Russell, I wanna thank you so much for joining us today and
sharing your incredible expertise on this topic that not every.
Physician thinks about as they go through their days and think about their patients.
And thank you for all the great work that you're doing and for more
information, you can always visit our website at uab medicine.org/physician.
That concludes this episode of UAB Med Cast.
I'm Melanie Cole.