Selected Podcast

The Importance of a Good Bedside Manner (even Online)

Michael Zaboski MD will talk about why connecting with patients is more important than ever before, whether in person or via Telehealth, and the difference it can make in people's lives.
The Importance of a Good Bedside Manner (even Online)
Michael Zaboski, MD
Dr. Zaboski joined Trinitas in 1990 in private practice with Dr. William McHugh. He was also appointed to the teaching staff at Trinitas, and has been an active associate professor of medicine for both Seton Hall University and now Rutgers University as well. Recently, he was awarded Faculty of the Year for Internal Medicine at the Trinitas/Rutgers NJ Medical School Class of 2020 graduation.
While attending medical school at Saint George’s University School of Medicine, he received extensive experience in wound care management in his surgical rotation at Queen Alexandria Hospital in Portsmouth, England. He was named Chief Resident at St. Elizabeth Hospital, whose program converted to the Seton Hall University School of Graduate Medical Education. During the conversion of Saint Elizabeth Hospital to Trinitas Hospital (before it became TRMC), he started as treasurer, then became vice president, then president of the medical staff. He recently joined the Wound Center Staff.

Caitlin Whyte: When you think of the best doctor you've ever had, they probably had really good bedside manner and that is more critical than ever during the COVID-19 pandemic, making people feel safe and cared for. Joining us today is Dr. Michaels Lebowski from the center for wound healing and hyperbaric medicine at Trinitas regional medical center.

He's here to talk more about connecting with patients in person online and why it makes a difference. This is Trinitas health chat, the official podcast of Trinitas regional medical center. I'm your host, Caitlin Whyte. So Dr. to start us off, why is good bedside manner so important? You know, especially these days in the midst of the COVID-19 pandemic.

Michael Zaboski, MD: Well, I think that during the pandemic, people have lost many of their normal connections with their, their friends, their family they've been completely isolated. So when people come to see a doctor say for me at the wound center, for example, we may be the only connection they have. For a whole week or for days.

So I think they really need that extra. And the human connection is what really creates trust between people. And so if you really don't make a connection, I don't think people really trust you as a doctor or caregiver.

Caitlin Whyte: Now, what would you say is good bedside manner? What is it to you?

Michael Zaboski, MD: I think it's being able to listen to the patient first.

And try to get their take on what's going on to get down to their level and not pretend that you're any better or smarter than they are. I think people inherently know there's something wrong when they come in for a medical problem. And they're the best one to tell you what that problem is. So when I think of bedside manner, I think the main thing is to go in with the attitude of I'm going to listen to what this person has to say.

First and try to keep my mouth shut at least for a few minutes until I hear what they have to say. And I think that produces the best competence of people that they know I'm listening to them, not just trying to get them in and get them out.

Caitlin Whyte: Now. Telehealth has been all the rage, especially in the last year, you know, during the pandemic is bedside manner still important when you're not physically by a patient's bed.


Michael Zaboski, MD: the middle of the pandemic. I had put my private practice on hold for inpatient visits, partly because no one was going to come because there was kind of a lockdown where no one could travel. And also my office staff were extremely worried that people were going to come in with the virus and everybody in the staff, we could sick.

So we, we did this kind of a lockdown and had to do something. So at first we were thinking phone calls, but then we realized we could do televisits. And I found to my surprise that there was actually, you could make a good connection on a television. At first, I thought it would be very cold and sterile and you really wouldn't get it.

But when you see a person's facial expressions, when you see how they respond to the things that you say. It has a connection for me. And I think it was going the other way as well. Patients said, Oh, I feel so much better seeing you now because I've known some people for 30 years and we had a really close relationship and just seeing one friendly face.

When, you know, you've been under locked down all that, while was a relief for people. Well,

Caitlin Whyte: let's dig into COVID-19 a bit more, how has it affected doctors and healthcare workers and that doctor patient connection?

Michael Zaboski, MD: Well, we've, we've suffered too, because I think we partially live off of the gratitude, dissatisfaction that we see in people getting better.

And that was taken away from us also. And the other there's a couple other issues. One was we couldn't physically contact people. And that's very important for some diagnoses. Also physical contact brings you closer to the person, you know, just touching their back or holding their hand or feeling a pulse, gives you a connection to a patient.

And without that, we lose some of our arts tools and strength in medicine.

Caitlin Whyte: Tell us a bit about what it's like working with patients in the wound center, as opposed to the emergency department or in a private practice. How does that change your interactions with your patients?

Michael Zaboski, MD: It's similar in some ways will unfortunately a lot of room patients have chronic wounds, which means something that isn't a wound that's not getting better for over three weeks is typically chronic wound.

And in those circumstances, they're often chronically ill or have a lot of medical problems. So they tend to be people who are fairly beaten down. A lot of them are also elderly. And debilitated, they have poor diet, low nutrition issues such as that. So in those circumstances, those people need a lot more connection.

I think they have very little human connection. Many of them, they become isolated from either age and lots of friends and family, or some of them are from nursing homes. So they, they really. Need more help in the wound center then say in the ER or my private practice, most people that come to the private practice are fully ambulatory day.

They drive in, they, they have family to bring them, uh, and the ER is very similar in the ER, things are different because it's an acute problem. Where often they're very sick and we don't have as much worry about that human connection as much because it's a lot of it's technical stuff that just has to get done.

Caitlin Whyte: Now I understand your healing rate is at 95% in the wound center. What makes it so successful?

Michael Zaboski, MD: Well, part of that is we look at a holistic approach to patients. So wounds don't just happen out of nowhere. People just don't wake up one day and have a wound. There's a whole history behind why that happened.

Some cases it's obvious like a trauma. You know, I, I had a guy put a hot water bottle on his back and it broke and boiling water. Scalded did most of his back. And that was one wound that took a lot of work to get better, but did get better. Other wounds occur from people who are so bedridden, bedbound that they, uh, they get ulcers on their backsides or on the bottom of their heels.

And these are very difficult wounds to heal and we're successful because we look at the whole reason, like why is this person in bed so much? What, what is wrong with the bed? What is wrong with the person? Are they incontinent? For example, do they have a poor diet and low protein? Are they getting enough vitamins and nutrition?

We look at all of these things in the wound center. A lot of times I've gotten wounds in people's legs where they'd been told it's well, they have bad veins. But what we're finding is that it's actually something called vasculitis where there's some inflammatory condition where the body's attacking its own cells and creating the ulcers.

But those ulcers would never get better unless we knew what it was. So what I do is if I have any suspicion, when people first come in, I do a biopsy and then we can find out what the problem is right off the bat. And then refer that patient for a proper treatment or we've done the treatment ourselves.

Um, so we're trying to do more than just put a special bandaid on a wound, just put a graft on, because people get these guns five, six times and they don't get better because. The substrate, which means the, the essence of the person's wound healing ability is poor or something is wrong with it. And that's what we try to do is fix that and turn off that problem.

So I think that's why we've had so much success because we're working on kind of a multidisciplinary approach.

Caitlin Whyte: You kind of touched on my next question already. But how common is it to have a non-healing wound? I mean, you gave us some examples about accidents and things like that, but how does one avoid having a wound get to the point where they would even need this center?

Michael Zaboski, MD: Yeah. I mean, some things are unavoidable. So one Mormon, one woman slammed her door and a mirror fell down and glitter almost chopped off the bottom part of her leg. You know, you can't, it's hard to avoid something like that. It was just a. The mirror wasn't properly hung up, but those cases you can't do much.

But a lot of wounds that we see are due to the chronic condition of a person. The wound is really a sign that the person is kind of losing energy and losing their ability to survive. So what we can do in those cases is try to stimulate people to have a better diet, improve their nutrition. We want to get them a proper bed that has say.

Air mattress that rotates and moves the person. We want to call attention to caregivers that if they're incontinent, we've got to try to fix that continence problem or put barriers in to protect them. So some of it is preventive management. Once a wound occurs, some of them are extremely resistant to getting better.

You know, I've, I've seen patients with wounds for who've had wounds for four years, come to the wound center. They just haven't been able to get it better because the problems that caused the wound in the first place weren't addressed

Caitlin Whyte: and wrapping up here, just touching on bedside manner again, why does it make a difference in people's lives?

Michael Zaboski, MD: I think it makes a huge difference. You know, humans are by our very nature, social and our social interconnection is really what gives people the most joy. And the most satisfaction in life. And you should get that when you have your medical visit, it's, it's a social visit. You're meeting another person and you're putting sometimes putting your life in their heads.

So it's almost required for someone to have a good bedside manner in order to. Get the trust from the other person that says, you know what you're doing and I'm going to help you. And they have to trust you in that. And the only good way to do that is a good bedside manner.

Caitlin Whyte: Well, thank you so much doctor for being with us today and thank you for listening to Trinitas health chat.

To find out more about how Trinitas regional medical center can take care of you. Visit Trinitas You can also call the Trinity center for wound healing and hyperbaric medicine at (908) 994-5480 that's (908) 994-5480. Turn into Taz health chat is the official podcast of Trinitas regional medical center.

I'm Caitlin Whyte. We'll see you next time.