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.