Paging Dr. House: Physicians’ technical skills matter more than bedside manner

“Forced to choose between a doctor with excellent medical skills and one with an appealing bedside manner, patients go with the doctor who has the greater technical expertise, according to a new report.”

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    It should not have to be a choice.
    ‘Bed-side manner” sounds like a hat the MD pops on to address the patient. I would think the goal of anyone in the medical profession should be that of a Healer extending the utmost respect, compassion and of course knowledge to his or her patients .I can sadly report that as the mother of a daughter who has struggled with a serious illness since adolescence, the “bed side manner” (if this is still the medical school terminology), was rarely decent or acceptable as demonstrated by many doctors who have treated her. And YES we have a PPO insurance policy.
    Fortunately there were a few gems among the stones that showed an excellence in “human relations skills”,
    that we were blessed by, and also encouraged to set a standard of practice in our expectations, as patients, receivers of care, costumers if you will.
    If there is not room in the academic load of medical students to include extensive training in human relations,_communication with special needs, children, the geriatric community, then it should be built into residency time, or perhaps even added as a required short summer terms. It should also be an intrical part of evaluation for certifications as general practitioners and all other specialties.
    I just read a piece of research in the book BLINK,
    by Malcolm Gladwell, that proves people DO NOT SUE doctors whom they LIKE.
    This research should get the attention of the almighty insurence companies who continue to act as DOCTORS, even though its illegal; thus making good practice almost impossible for many doctors.
    IF they could get some actuaries to run the money saved numbers if law suits decreased by 80 or 90 %: then a radical change in what they expect could occur.
    I apologize for the length of this response.

  • Dr. G

    Overall this is an interesting BIG question: do people want the job done right- or are they happy with the service? I won’t go to a restaurant for bad food, and I won’t go there if there is a long wait and the staff are rude and take me for granted. What about the gray areas though? Can food ever get so good that I’d bear with poor service, and conversely will I eat bad food for essentially the company kept? The answer is yes for both. If I was starving, i.e. my life depended on it, I’d tolerate poor service, and if it was my family and friends I have and would tolerate bad food, sometimes on a daily basis… There are those types of doctors, too; the ones that save dying or critical patients from the ravages of terrible diseases and the ones that are your everyday family and friends.

    My experience is they are rarely found in the same person. I loosely believe that they shouldn’t be.

  • TXMed

    I’m shy, I have less than average social skills and yet in four years I’ll be a physician.

    I’m a great listener but being quite is often viewed as beeing anti-social and I imagine will be viewed as poor ‘bed-side manner.’ This is clearly an unintentional fault bred in an unavoidable personality flaw; yet if the application of my knowledge is excelent when caring for patients, isn’t that what is truly important?

  • Elliott

    I think you need to work on your bed side manner or whatever you want to call it in order to be the excellent physician you want to be. A lot of your job is going to be about communicating. Look at the statistics on pharmaceutical non-compliance or the number of prescribed lab tests that are never done. What that means is being a good, caring communicator is not just about not getting sued although there is that, it’s about getting your patients to work with you as partners to help them stay healthy or get healthy. You would expect your fellow students with technical skills that did not meet your standards to recognize that deficit and work on improving even if they are not as smart as you. Why not take the same approach with your social skills. Just my 2 cents.

  • jb

    This is a superficially intriguing question but ultimately absurd. It really depends on how sick you are. If your cough is due to a self-limiting viral infection, you want to be reassured in a friendly, confident manner by someone who is interested in setting you at ease. If your cough is an early manifestation of lung cancer, you want someone who will relentlessly do his or her best to eliminate the cancer. If you can find someone who has done this successfully on numerous occasions over a couple of decades, you are unlikely to change doctors in the middle of a treatment course because his approach is lacking in warm fuzzies.

    It is true that patients are more likely to comply with a treatment course if they have confidence in the doctor, and “bedside manner” has a lot to do with this. The problem is that the judgment of whether a doctor has a “good bedside manner” is a totally subjective decision that is reached entirely by the patient. Nobody likes everybody and nobody is liked by everybody, and these impressions may be reached under conditions of extreme stress, confusion, and fear (if the patient is truly sick). Often there will be several family members involved, some of whom will think that the doc is terrific, and some will think he’s a jerk. Add to this mix the possibility of an unfortunate/undesired outcome, and it’s clear that most people will be better off aiming for competence and hoping for the best in the bedside manner department. Patients can certainly shop around for a doc they get along with for primary care and possibly for chronic problems, but otherwise these days a lot of medical care is episodic and trying to find a good personality fit will take a lot of time and money, for an outcome that may not be improved.

  • Maurice Bernstein, M.D.

    “Bed-side manner” is currently considered in medical school definitions as a dramatic acting behavior and which is scripted and learned. We don’t teach bed-side manner. True empathy is NOT scripted. Attempts at understanding the bio-psycho-social aspects of the patient and the illness is NOT scripted. Attempting to simply care for the patient, rather than acting like the physician cares is NOT scripted. And there is no script of acting regarding how to make that all important intellectual and spiritual connection with the patient. Students learn that the goal is to become a trusted, understanding and caring physician. They attempt to reach that goal by trial and error with patients under mentoring by role model teachers through expressing the student’s own personal qualities, behavior and technical skills. The technical skills are all part of the goal to provide care to the patient. Each physician will appeal to the patient in different ways regarding trust, understanding and care and it is up to the patient to select, if possible, that physician whose behavior is most comfortable to the patient. ..Maurice.