The purpose of concept analysis is to recognize, define, and clarify phenomena to improve understanding and promote further research. A concept is a phenomenon that occurs in nature or in thought and is derived from certain attributes. Through the process of concept analysis, ideas area broken down and analyzed through identification of key features of the concept. These features include: attributes, which are the characteristics that define a concept and are consistently seen when the concept exists; antecedents, which is what must occur for the concept to exist; consequences, or the results of concept existence; and, empirical referents, which are phenomena that, by their existence, demonstrate the occurrence of the concept ([₁₂]).

The concept of bedside manner warrants analysis and scrutiny because good bedside manner is highly valued by patients, yet bedside manner has received minimal literary attention ([[[[13; 14]]]]). One study showed that patients value good bedside manner and listening skills more than clinical competence ([₁₃]). In addition to patient satisfaction with care, good bedside manner has also been implicated in improving overall health status ([[[[5; 15; 16]]]]). The relevance of practitioner behavior in medical care has been said to be of greater importance to customers than in other service professions. This increased significance has been related to the fact that the customers must bare themselves both physically and emotionally ([₁]). While the value of good bedside manner has been established, specific behaviors and actions that dictate and guide this experience have received little attention ([₁₄]).

The term bedside manner dates back as far as 1869. The Merriam-Webster dictionary definition of “bedside manner” is “the manner that a physician assumes towards a patient” ([₁₇]). For further clarification, the term “manner” is defined as “a way of acting”. The term “bedside” literally means “the side of a bed” ([₁₇]). In healthcare, references to “bedside” may have the literal meaning of being by a patient in their bed, or simply imply a personal encounter with a patient.

From these definitions, the assumption can be made that bedside manner is a behavior or group of behaviors. All human behaviors have been theorized to result in a multitude of consequences; intentional and unintentional, positive and negative ([₁₈]). Considering the consequences of human behavior, it can thus be assumed that health provider behaviors, communicated through an encounter designated as bedside manner, result in an experience for patients, one that may be perceived as positive or negative.

Various provider behaviors have been identified by patients as consistently positive or negative. Verbal communication skills are reported as very valuable when patients assess the performance of their provider ([[[[15; 16; 19]]]]). One study that assessed the value of communication skills found that physicians who where deemed as being good listeners had the best relationships with patients and the least amount of complaints ([₁₅]). A similar study reported that patients related bedside manner and listening skills with the feeling that their clinician really cared about them ([₁₆]). Specific to advanced nursing practice, research has identified communication skills and longer visits as a favorite aspect of APN care ([₁₉]). Non-verbal communication, such as neat appearance and body language, have been said to relay a positive impact on patient’s perceptions of provider bedside manner as well as effectiveness ([₁]). Other non-verbal cues associated with a positive experience for patients include eye contact, body position, and tone of voice ([₂₀]).

Humanistic behaviors such as care and concern are also frequently reported by patients as positive and desirable. One study of patients cared for by APNs found a statistically significant correlation between patient satisfaction and the feeling that the nurse practitioner was caring ([₂₁]). Additionally, Finch ([₂₂]) questioned patients as to what behaviors and actions were expected from nurses, with “caring” as the most common response. “Caring” was described as concerned, compassionate, genuine, and kind ([₂₂]). In the United Kingdom, a national summit sought feedback from the public of their expectations and desires from primary care services. The findings revealed that the public’s priority was care that was interpersonal, including sympathy and attention ([₁₁]). Findings from a study ([₂₃]) that asked patients what made a medical provider “good” reported sensitivity as the most common response. Similarly, Bendapudi and colleagues ([₁]) asked patients to describe their ideal doctor. The top responses were a provider who was confident, empathetic, humane, personal, forthright, respectful, and thorough ([₁]).

The literature also revealed information about provider behaviors deemed negative and related to undesirable and negative patient experiences. Luthy and colleagues ([₂₃]) identified good clinicians as being sensitive and bad clinicians as “self-serving”. An article discussing patient satisfaction with medical care cited “bad” providers as being arrogant, rude, dismissive, and indifferent ([₃]). Behaviors such as insensitivity, lack of respect, arrogance, disinterest, and impatience were reported when a group of patients were asked to describe their worst experience with a clinician ([₁]). Disrespect, distrust, and unavailability where also reported as negative provider behaviors ([₄]).

The review of literature revealed that patients typically described clinicians based on interpersonal behaviors with little mention of clinical skills or competence. Bendapudi and colleagues ([₁]) theorized that patients lack the knowledge to judge their provider’s technical quality. These authors also proposed that most patients view clinical proficiency as an expectation, perhaps limiting focus on clinical competence or expertise. Therefore, providers appear to be judged by what the lay person can readily assess, most often being overt behavior.

From the review of literature, concrete critical attributes of bedside manner do not appear to exist, and further, clear identification of bedside manner attributes has received little study ([₁₄]). The literature did reveal, however, common themes of patient-perceived encounters with positive or negative connotations. Positive provider behaviors were described as empathetic, friendly, listener, effective communicator, courteous, caring, and respectful ([[[[1; 2; 21; 22; 23]]]]). Terms describing bad or negative provider behaviors included rude, arrogant, dismissive, uncaring, and indifferent ([[[[1; 3; 23]]]]). Along with behavior, appearance was found to impact the patient’s impression of their clinician, including neatness and body language ([[[[1; 20]]]]).

In the case of bedside manner, the primary and basic antecedent is an interaction between provider and patient. Bedside manner, or provider behavior, will always exist when there is an encounter with a patient, yielding a positive or negative experience ([₂]). These interactions may occur in various settings, including medical offices, community clinics, hospitals, or by telephone. Since provider behaviors may be unspoken, such as body language, a verbal interaction does not have to occur for bedside manner to exist ([₁]). Current research also reports that good bedside manner is a skill, inferring that if one does not exhibit it, development and mastery may occur ([₂]). While good bedside manner is proposed as a learnable skill, specialized training in bedside manner is not included as an antecedent. According to Merton’s theory of human behavior, which states that all human interactions reveal behaviors with subsequent consequences, providers will exhibit intentional and unintentional behaviors when engaging with patients whether training on this interaction has been received or not ([₁₈]).

Consequences of bedside manner are dependant on each patient’s perception of the encounter and whether the provider’s behavior and the patient’s overall experience are deemed as positive or negative. A multitude of positive consequences of bedside manner have been demonstrated in the literature and are directly related to the patient’s perceptions. Research has shown that patients who feel that their provider has good bedside manner are more compliant with treatment regimens, have more positive health outcomes, and are satisfied with the care that they receive ([[[[5; 6; 7; 8; 24]]]]).

Negative consequences of bedside manner can be as equally dramatic as the positive ones. Patients whom feel their provider has poor bedside manner have been shown to be less compliant with treatment regimens, have poorer outcomes, and are generally less satisfied with the relationship with their provider ([[[[5; 7]]]]). Patients whom report that their provider does not listen to them hold the highest correlation with reports of poor bedside manner and less desirable health outcomes ([₇]).

Identification of concrete empirical referents for bedside manner is difficult due to limited research of the phenomenon as well as the subjectivity of the experience. In the presence of the phenomenon of bedside manner, other consequential phenomena will likely occur. Just as providers will always exhibit some sort of behavior toward each patient, the patient will have impressions and perceptions based on the experience. The challenge in universal description of empirical referents, similar to that of the attributes, is that each patient interprets bedside manner and the behavior of others differently ([[[[1; 18]]]]). Further research is indicated in this area to clearly identify those phenomena which coexist with good and bad bedside manner.