Choose your doctor: Astute diagnostician or empathic practitioner?

Would you rather your physician be an astute diagnostician or a compassionate and empathic practitioner? Of course, we want our physicians to be blends of these qualities. We want it all.  We want them to be chimeras of Drs. House and Welby. But, is this possible?

I can’t say. I suspect that it is easier to cultivate soft bedside manners than it is to teach medical acumen, although the latter was the overriding priority when I was in medical training. No points were awarded in our morning reports with the chief of medicine for holding a patient’s hand during the night. Big win, however, if the intern could recite 14 causes of hypercalcemia.  The message was that “hard medicine” is what really matters.

The importance of bedside manners depends upon the specific medical circumstance at hand.  Good bedside manners may mean less if you are going to see a physician once for a procedure than it would if the doctor-patient relationship were to be ongoing.

There has been more emphasis on medical humanity in medical training in recent years, although the trajectory has not been a straight and steady incline. Resistance to reducing excessive and oppressive work schedules of interns and residents is still viable, but progress has been made. I’m not suggesting that medical interns work a 40 hour work week, but I do reject that exhausted and somnambulating house staff are a necessary feature of medical training and education. And, if medical ‘reform’ keeps progressing, how much dedication can we expect from house staff who will later join the ranks of employed physicians who are on a time clock?

Perhaps, shift work doctors will have meaningful doctor-patient relationships. Since these physicians will have more of a life, perhaps they will relate better to their patients as human beings. I’m not certain of this, but I offer it as a possibility.

Bedside manners versus brainpower

I have come to appreciate how important are the soft sides of medical practice. Of course, medical knowledge is critical, but medical judgment is paramount. We’ve all seen medical geniuses who wielded a clumsy clinical axe. Conversely, we’ve admired great healers who were not scholars. If I’m sick, I’ll pass on the medical prodigy in favor of an excellent listener and judicious practitioner. Remember patients, no doctor has it all.

Here are a few clinical scenarios I’ve encountered recently that require a non-scholarly remedy.

  • A physician is interviewing a man with hepatitis C. His wife is at the bedside. Do you ask then about a history of intravenous drug use, which is an essential question in this circumstance?
  • A nurse gives a patient more sedation than the physician ordered. Should this be reported to her supervisor if no adverse consequence occurred?
  • A colleague requests that you do a procedure on an elderly patient that can be medically justified, but isn’t truly necessary. What should the procedurist’s next move be?
  • A patient is convinced that his complaints have a medical explanation, although the physician strongly suspects they are psychologically based. What’s the doctor’s game plan here? One false step and the doctor-patient relationship may be ruptured.

Physicians wrestle with these kinds of issues every day. Sometimes, we get them right and sometimes we misfire. We’re not perfect, even though we often feel that this is the expectation. Not surprisingly, different physicians have their own individual approaches to medical and ethical issues.  Every physician is unique by virtue of different training, personality style and experience.  I wonder how the pay-for-performance panacea will measure all of this.

Doctoring is tricky business, and we don’t know the specific ingredients and proportions that constitute a great physician. There is no recipe. It’s an amorphous mixture of humanity, humility, medical knowledge, clinical experience, excellent communication skills, compassion and personal warmth.  And, of course, we’re supposed to run on time.

As patients, which qualities in your physicians do you value most?

Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.

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  • karen3

    I have had some very difficult to diagnose conditions. In every instance, the doctor who figured it out had the compassion to hear me out and really understand the symptoms and was also technically strong in his/her specialty. It takes both brains and a connection to patients to get a good outcome. The patient has half of the solution to problem — what is subjectively going wrong and the physician has the other — the data on how the body is *supposed* to work. If you can’t marry both, there is no solution.

  • carolynthomas

    My longtime family doc once referred me to a specialist she described like this: “You’ll hate him! He has a bad reputation among all my patients I refer to him because of his terrible bedside manner and non-existent communication skills. But he IS a brilliant diagnostician – and he’s who I would want to see if I were you!”

    Why, though, is it unrealistic to expect minimal people skills to go along with the solid clinical knowledge that I’m assuming most doctors have picked up in their training? We’re not talking here about researchers/scientists who hang out at the back of the lab with minimal human contact here – we’re talking about those who actually decided to go to medical school so that they could spend time interacting with PEOPLE at some point.

    I’m not expecting to become friends with my doctors, I don’t have to go camping with them, I don’t expect hand-holding – but I do think making eye contact and introducing themselves to patients represent the very bare minimum of basic common courtesy that, sadly, many docs seem entirely clueless about. I honestly doubt that we can “teach” health care professionals how to have a personality, but maybe there’s a way we can somehow beat some of the social cluelessness out of them. More on this at: “The Lost Art of Common Courtesy In Medicine” – http://myheartsisters.org/2011/12/27/the-lost-art-of-common-courtesy-in-medicine/

  • http://twitter.com/BoomerHighway Elizabeth A. Havey

    I value them both. Depending on the situation, I would allow for abandoning empathy and going for the acute diagnostician. Beth RN at Boomer Highway

    • Tanya

      I have had an incurable disease since i was 3 and I have seen so many doctors, let me tell you what I say to the ones who start out treating me like a number without eye contact and appear not be listening to me, I say “Listen Dr. whatever I pay you for a service I expect to be heard, listened to and expect you to acknowledge me, if you can’t provide the service you are being paid for I will be happy to take my business to someone who will” I have never had this not work. Sometimes they have to be reminded that you are paying them, and that what they do is their job they chose. the fact that it is their job and they are not above you who pays the bill!!!

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