Here is pretty good "essay" in the NY Times by a Dr. Lisa Rosenbaum, M.D. She is a fellow in cardiology which means she really hasn't been out in the real world for any extensive amount of time yet. That being said, she does go off on the new fad of finding nice and empathetic doctors. She starts off with:
My father the doctor told me that when he was an intern, the competence of his colleagues was inversely proportional to how much their patients liked them.
That rule probably isn't true but it does make one think. As I blogged in the past, our job is to help people and sometimes that means giving bad news, giving unpleasant recommendations, or just giving tough love. I try to be nice and respectful to all my patients. Sometimes I lose my way. Sometimes I am perceived otherwise. I do my best. The future idiots who want to measure our "niceness" will only lead us to bad consequences. Please read Dr. Rosenbaums piece and tell me what you think.
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If you can't/won't communicate well with your patients, you shouldn't be a doctor who sees patients.
That being said, I grow weary of all the academics and non-physician administrator types who continue to hand down edicts from above that I, as a primary care physician, need to cover everything under the sun in a 20 minute well check, since I'm sure none of them have actually tried doing that.
Although Dr. Rosenbaum's article was well written I would like to see the same topic handled by a psychologist. As we know, your perception of something can be totally opposite of mine therefore the old saying stands true, "you can't please everybody all of the time............" In this life I've found it suits me best to remember that if I've done the absolute best I can in anything then it is what it is. If I can sleep with myself at night, then what I've done must be all right. Peace!
The problem with her op-ed is that it confounds two issues. (And in response to Carol Blackburn, I am a psychologist and a former epidemiology prof.)
The true critical variable is effectiveness at communicating, not "niceness" or empathy. But that communication skill, by itself, is simply dangerous--indeed, it's the hallmark of a charlatan. It needs to be built upon a foundation of knowledge and clinical competence.
There's some very interesting work being done at Mass. General Hospital and Harvard Medical School by Helen Riess, M.D., on how a competent clinician can improve patient outcomes by using some specific communication techniques.
It's interesting that this post was juxtaposed with the one on mammograms. The public response to the new data on screening mammograms/PSA testing/flu vaccine effectiveness/alcohol and breast cancer demonstrates two things:
1. Most people, including a lot of health care professionals, don't understand statistics. This shouldn't be surprising--just visit Las Vegas or look at who buys lottery tickets.
2. You cannot effectively make a logical argument against an emotional argument. Yet that's what health care professionals mostly try to do.
She is indeed swirling among at least three concepts. Two items that I see lacking in liability (and just really angry patient situations) are effective communication (choosing the important facts to convey and doing that in a way the patient understands, a cousin of health literacy), and empathy. Those have no real relationship with demeanor, which seems to be what she talks about. I have seen fairly crusty physicians convey empathy with a "well doesn't that suck" sort of comment. If it's heartfelt, it will probably carry the right message.
I spoke with a nurse whose husband had died recently of an MI. She was angry, feeling that not everything proper or possible had been done for her husband, but was very impressed that his cardiologist was so visibly moved, even "with tears in his eyes", and cited that as the reason why she did not pursue legal action.
That sent a chill into my soul. I said to this medical professional "Let me get this straight, you thought that your loved one got substandard care, but reconsidered because of the feelings demonstrated to you by the doctor?? So your assessment of the quality of your husband's care was the overtness of his doctor's emotions??" I was torn between sympathy for her and cold, dark anger at her willingness to even consider going after a cardiologist until he choked up in front of her. Those of us who do not like to share our emotions are even bigger targets, based not on quality of care, but on outcome. Thus evolves the doctor-patient "relationship."
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