The findings mentioned in this article are also found in the psychotherapy research literature. Outcomes are stronger with therapists who develop and maintain warm and empathetic relationships with their patients. Patients who feel seen and understood better mobilize their internal healing resources. A therapist's high level of experience and expertise cannot overcome a poor working relationship.
3
Why do these essentially same stories get reported over the years with surprise?
3
As an adult education teacher in a county jail, I was required to teach inmates who may or may not have been courteous and willing to work. I could have been snarly and autocratic towards them, behaviors I observed in some of the deputies who oversaw jail routines. But I chose to adopt a kind and cheerful method of imparting information so my students could progress in their studies. I didn't always like them, but after some years of practice, I learned how to project a firm but caring delivery in my teaching, and generally got good results. It certainly made my workdays less taxing for me, as well as for the inmates whose lives were already a struggle.
Every job requires an MO to get the work done in the best possible way. Having had way too many encounters with doctors in the past year because of illness, I had the opportunity to observe a variety of professional behaviors. For the most part, all my doctors have been kind and cheerful, doing their best to make me feel comfortable while they did their jobs to attend to my medical needs.
Whether they are kind to me because they like me is not the point. I understand from my own experiences that being kind to the people you serve in your job is something you learn, a way of behaving from the time you walk in the door till you go home. At some point it becomes a habit, and you genuinely feel it, even on your bad days.
4
I would add that the converse is important as well. Patients should think about how they behave with the physician. In my experience, people have become more rude over the years. it is not uncommon for a patient to tell me that they have looked something up on the internet and self diagnosed , and get angry and confrontational when I gently try to explain why the Web may not have gotten it right. Or they show up 20 minutes late for a 15 minute appointment. Or they don't show at all. It is a really good day when I have patients who are as polite and considerate of me as a physician as I try to be of them as a person.
4
I have always believed that what "alternative" practitioners provide that make them so effective is that they are nice to the patients. Physicians think they can get away with arrogance and ego-enhancing practices, but alternative practitioners take the time to be nice and sympathetic and offer what seems like helpful suggestions.
4
Showing a patient and their family that you care and are listening to their concerns does not necessarily take more time. All providers should be present and engaged during each visit, focusing on the person in front of them and for the moment at least, pushing other thoughts aside. Every patient deserves this attention and should expect it from their providers, whether they are Physicians, Nurse Practitioners or Physician Assistants. Find a provider that makes you feel cared for and is competent in their assessment of your health issues. As for people who think they will be better served by a Physician vs a Nurse Practitioner or a Physicians Assistant, I would tell them to look at the person in front of them instead of the initials behind their name. One in three Primary Care Providers are now NPs and PAs in the USA and many do a great job caring for people in their communities. Find the provider that works for you.
1
I have G-I problems and my Gastro Dr. never seemed to understand or care about my symptoms. He got a new Nurse Practitioner and in one visit she listened and cured my ailments.
3
I was put off by a surgeon who had a limp handshake like a cold, damp dead fish. I found it hard to imagine she had much manual dexterity! Her nurse (PA?) had a similar handshake. Maybe people are no longer judged on handshakes, but I found that unnerving.
3
Good studies about patient/doctor releationships, but there is more that can be done to improve the lives of patients and their care givers. It is well known that words affect patient attitudes and that patient attitudes affect patient outcomes. If there is one word we should eliminate from the English language, that word is "cancer." It's a toxic word with 100% negative connotations. Hearing "cancer" in a diagnosis is like being pushed off a cliff. Change that word to something that is accurate but different, such as "CGD" (cellular growth disorder) and we will improve the lives of millions of people every year. You can start right now, by telling your doctor that you don't like the "C" word and prefer CGD. Change comes from the ground up.
3
You better believe it can. Much of non-compliance with treatments, medication et al is at times down to the either instant and or over time dislike of the patient for the doctor and thus their inattention to the doctor and or their instructions.
I know patients seen by one of the "greatest in their field" state categorically I will not be treated by that doctor. If someone potentially facing a fatal disease would rather face it without the "greatest in their field" is telling.
Both compassion and competence can be demonstrated in a brief period of time as can its opposites. Patients realize that time is at a premium in healhcare. Acknowledge that you are speaking to another human and that you yourself are also a human who is also a physician. You can then easliy move forward.
5
What else is new. I am 83 in my new home and in my lifetime on my fourth internist. #3 was perfect. A great diagnostician, and a great listener, with warmth and a sense of humor. #4 is all business. Tell her what hurts, and she recommends a specialist. I am hoping to find someone better
2
While it should be self-evident, it’s reassuring to know that studies demonstrate that the authentic, compassionate, un-rushed treatment relationship is itself a key component in the healing encounter.
But here’s what studies don’t yet focus on. Just as patients do better in healthcare relationships which are guided by authentic caring, knowledgeable presence and compassionate communication, so too do doctors (and nurses and all other healthcare professionals). The authentic caring relationship “works” not only for the patient; it fulfills the doc’s sense of purpose. Depriving the doc of that meaningful interaction is not only detrimental to the patient and his/her illness outcome, it’s deeply detrimental to the doc, progressively erosive to the doc's psyche. And the longer that depersonalization goes on, the more meaning-deprived the encounter becomes. And with that, the angrier and more short-changed the patient feels and the more empty the doc feels. And I suspect that most docs are not even aware of this major source of their discontent.
So, while improved patient outcomes are the main focus here, it’s vital to be aware of the mutually reciprocal benefit, the deeply satisfying and healing dynamic that occurs in the authentic and compassionate relationship between healer and patient.
13
I am fortunate to have a primary care doctor who takes whatever time is needed when patients come. I've been with him for over an hour and he LISTENS! He has his own independent office and is beholden to no hospital.
I never feel bad when my appointment time is never met. I wait because I know that someone else is now needing his attention.
He has his own pharmacy that dispenses alternative products. Some of them he has used and created himself. He studies the statistics and knows they all help. He gives one lecture a month on meditation and then gives a power point presentation on the 'discussion of the month'.
If a doctor cares, he/she does more than wait for the money that comes from all of us 'walking ATM machines'.
5
I went into Mass General last week to see my cardiologist, a doctor I hold in the highest esteem. After waiting an hour, a physician's assistant talked to me for a few minutes, took my blood pressure, and handed me a sheet of paper to hand in when I checked out. I asked about seeing my doctor and was told that this physician's assistant was seeing established patients so that my cardiologist could see new people. So much for the doctor-patient relationship. Evidently, Partners HealthCare considers it expendable and of no value.
11
Refuse to see physician's assistants and nurse practitioners - they have a fraction of the training, most of it non-clinical and online. Do not see them and insist upon seeing your doctor or switch to another practice.
4
@Lori Kaye
While it's true Physician Assistants do receive less training than MDs, it is not "non-clinical" or online. I couldn't guess where you heard that. In fact there is only 1 online program in the country, and even they have mandatory clinical hours.
There are published studies showing health systems that utilize PAs/NPs have just as good outcomes as MD only systems. Not to mention many patients actually prefer to see Advanced Level Practitioners as they feel they have more quality time with these clinicians.
Also, there is no apostrophe "S" in the title. See above.
1
@Kamran Boy, do I ever disagree. I researched and chose the doctor, not the PA. I am forced to pay the same for both. Perhaps for routine follow up I might agree to a PA, but definitely not for the initial diagnosis or if the treatment did not seem to be working.
2
The overriding feeling I get today when I engage face to face with physicians and their staff is that they are a cog in a big, bureaucratic profit-seeking industry. The 15-minute billing segment—which delivers 5 minutes, at best, with an actual physician—is the prevailing experience. You are put into a process that, might, deliver a result after so many 15-minute units. Nice is nice—if it includes focus and actual diagnostic savvy—but it’s still like starting a race with many laps to go.
I don’t have a lot of sympathy for physicians, but the gatekeepers, PCPs and generalists, are no doubt experiencing some of the “I’m just a number” (dollar sign) in this process. Specialists, no sympathy. They are participating in unconscionable pricing schemes with both hands.
6
@JP
Your comment reeks of a lack of understanding of how modern healthcare has impacted the practice of physicians, the economics of medical training and the personal sacrifices we are required to make for the privilege to treat patients. Doctors are overworked and at the very least, often times not, paid fairly for the job and responsibility they carry. This problem is particularly true for the primary care specialties Most docs these days are deeply dissatisfied with the current state of healthcare. If you want to point the finger at someone for your rushed 15 minute visits point it at big medicine and the hospital administrators. If you are seeing a primary care physician in a private practice it is likely that you are rushed because economics dictate that they see 30-40 pts per day to keep the lights on and put food on the table. Your experience won’t be much better at a large corporate hospital (see Kaiser) where all employed docs are given production quotas to make a profit or at least break even.
1
I feel that if a doctor cares, he/she is more inclined to listen. Listening is essential in diagnosing an illness.
13
I am an Indian army veteran, 70 years young! My company is onto real estate development since 1995. For the past 19 years we are into senior living and care of the elderly in a number of places in India.
I entirely agree that touch and feel besides talking to patients by making eye contact, not being rushed for time are very important . We do not like Doctors or caregivers sending signals of disinterest or being short of time.
We used to have the concept of Family Doctors when we were young. That breed has almost vanished in India, where because there is no insurance from the Government, everyone goes to Tertiary multi-speciality hospitals.
There the doctors are so busy they are listing various tests and rarely using even the stethoscope. The diagnosis is through multiple tests - mostly unnecessary.
In the concept of Polycare that we set up, all patients are seen by the GPS who have time for the patient and do not order unnecessary tests. More than 80% of patients are treated by General Practioners and for the rest we have Specialists in our panel. We maintain medical records which can be transferred to hospitals in case a patient is admitted. Care is by compassion. Empathy to the patient is visible. Cost of health care is drastically reduced.
We insist on our staff to show their concern as they would do to their kith and kin. Patients get routine calls to check their status.
Yes, we. We’d Doctors who talk and show empathy.
7
I'm a primary care provider and I enjoy being nice and making eye contact and small talk/banter with patients. That's also why I have hours of charting left to complete tonight. I think this article helps showcase why naturopathic medicine is becoming more and more popular, since patients appreciate providers who spend a lot of time with them, make them feel heard, and make eye contact, even if the care provided doesn't actually meet medical standards. I'm find this particularly striking since I received records for a new patient that showed heavy metal testing and other not medically appropriate workup. On googling the provider's name, reviews popped up raving about how wonderful this naturopath center is since all new patient appointments are an hour long and the quality is clearly better than standard clinics where physicians can spend only minutes per patient visit. There's only so much "nice" i can squeeze into a 10 minute long appt when I still have actual medically and scientifically based recommendations to include too.
15
@C
Unfortunately, most of the minutiae we are doing in the 10-15 minute visits have less to do with science and more about press ganey. As physicians, I think most of us TRY to also add the science and compassion into the visits but the administrative side of medicine has been squashing those most essential components of patient care.
4
As a female healthcare provider for almost 30 years, I experienced varying responses from my same gestures. For example, some took my gentle talk as lack of experience, some felt that it relieves their stress of seeing doctors. if I offer them with lower cost treatment option, some thought I disparaging them of not being able to afford other treatments , if I advised them with higher cost options, some thought I intended for higher profits! As matter of fact, either way can be my genuine advise based on what’s the best for patient’s need.
I never feel comfortable to shake hand with my patients, I think that’s a gesture more for businessman. I greet my patients with their names and warm smile. I let them do talks and I listen, I present facts along with x-ray, pictures and / or photos, research data, etc., and inform them about their estimate copayment or the cost right upfront! I would never worry about what the patients thought of me after that! I strongly believe that the best outcome lies in patient’s understanding of their problem, and be part of the treatment team, not just “ nice” gesture!
I can assure everyone that it’s seldom to find any healthcare students who were not striving to be the best providers in their career paths! Yet, majority of people feel that it’s hard to find a passionate, competent doctor nowadays, why is that? Maybe the answers to that question could be the key to revive the traditional healthcare atmosphere with more personal touch !
14
I believe this is part of the reason why "alternative medicine" appears to help patients. As these providers often accept private pay only, they basically have to be nice to patients or they will not have any business. They also typically spend more time with patients.
7
A caring disposition is essential - and hopefully a key reason why health care providers pursue their respective careers. But I have also observed the opposite - highly charming practitioners who are void of best (evidence based) practices and clinical skills. Patients deserve both.
6
Sadly, I've seen the same thing too many times. It frightens me to see patients in need being fooled by an ersatz caring response, while consciously being denied competent care. "There, there." It's true we need to show care in our profession, but this should never be used as a mask to cover incompetence. Providers should know what they know and know what they don't know. Blend that knowledge with patient respect and you'll have an excellent provider.
6
Oh wonderful, someone who never gave a death sentence of a diagnosis, someone who never saved someone from death or disability, someone who doesn’t know an MCA from a LAD is going to tell doctors how to do their jobs. The nicest incompetent doctors who are wrong will be wrong, and they are also under attack from weirdos on Yelp, their horrid EMR and admin bosses, and now by the social scientists, who weaponize burnout and the stress of time management against the doctor. This very article is part of a coming plague of nice over smart, over competence, over diligence, and the inevitable mortality, morbidity, and wasted resources that result.
8
@Dave — Please find another line of work, for the sake of your patients. Your arrogance is probably responsible for more pain and suffering than any of the illnesses you’ve diagnosed. You obviously don’t like your job, especially now with people telling you what to do. I’ve met you many times, and you were the main source of misery in my life. Fortunately, I’ve met some nice doctors, too: nice and smart (not mutually exclusive, as you seem to think). In spite of the hurried scheduling, overwork, paperwork, typing, and coding, some doctors still find time to connect with their patients on a human level. They posses a humility that arises out of true confidence, and it inspires trust. They are caring and compassionate. It’s not something that can be taught. It’s part of their genuine character and sense of altruism. And it does make all the difference.
13
@Dave If you read the article, this was not just based on the author’s opinions. There was a well designed scientific study to support the research question. Being “ nice” and being “smart” are not mutually exclusive. Medical schools are now placing more emphasis on how to enhance empathy in their students. It is now a requirement of the curriculum for accreditation. I did my dissertation on this topic and there are many ways to teach students to be more empathetic in their patient care. Learning physiology,anatomy,and disease is no longer sufficient.
4
@PL
The doctor patient relationship, and the respect that happens, is a two way street. Best of luck finding someone who’s humble but confident: sounds to me like you need a massage therapist, pot dispenser, or a faith healer.
As for the arrogant bit: ha! This is just an ad hom attack which reveals your true nature and says nothing about mine. I’m also blessed to be able to pursue my professional interests without the slightest administrative (or financial) hindrance. But please, please keep reading those Yelp reviews, going to the nicest doctors, and likely getting unneeded tests and procedures and even quackery!
1
A handshake is very revealing. A cold, retracted hand speaks volumes. Not offering a hand says even more.
5
A good surgeon I used to work with liked to say, “You don’t need to run chi-square” (a test of statistical significance) “on common sense.” The studies cited here are so poorly designed that they establish nothing more than the obvious: that people can often be convinced to ignore a mild itch. There are charismatic and sweet-tempered doctors who are good clinicians, and there are many with the same characteristics who are disastrous at taking care of patients. My advice: ignore yelp, which is a totally uncontrolled source of data, and pay attention to credentials and the opinions of clinicians and other patients that you trust.
13
The feeling that my doctor (PCP and especially a specialist) is competent and on top of my case, especially when a serious diagnosis is possible or likely is more important than "warm and reassuring." I always appreciate warmth and reassurance but for me, it comes when I have a strong sense of doctor competence.
9
Here's what I expect from a doctor:
1. Basic good manners. Read Emily Post. Introduce yourself, extend your hand, look the patient in the eye and don't turn to your computer unless absolutely necessary.
2. Listen to the patient. Don't tell the patient how the patient feels or how they should feel and don't ever accuse the patient of being delusional or a drug seeker or whatever. Just LISTEN.
3. Record a comprehensive medical history and review your notes with the patients to ensure that you and the patient are on the same page (I once reviewed my medical records to find that almost everything was incorrect from the reason for my visit to my symptoms and current medications to my ethnicity and race.)
4. Schedule appropriate tests.
5. Never say what the condition "could be" without definitive proof.
6. Never been condescending.
7. Never be dismissive.
8. Be straightforward and honest.
9. Follow-up
10. Above all, be sincere in everything you do. This is what it means to put the patient first.
If you do it right the first time, it will save everyone time and much, much, much money.
20
Sorry, but if I dont write some notes on my computer while your there I dont get to end my day. I can still be nice, make eye contact and type.
4
@mary, some note are fine, and sadly, expected. But I like to hear a 'hi' first! Not all manage that. And I DO attribute that to the insurance company pressure, not to rudeness. What a mess it has made of what wants to be a caring profession.
6
@Amy
I do not want to shake my providers' no doubt filthy hands.
1
Actually, I am not sure why anyone is surprised that a placebo effect can be measured as a result of being told things will improve. The placebo effect is everywhere!
2
I've already decided: I want a hospital (to go to or work in) with ZERO artificial intelligence.
"Particularly as artificial intelligence promises a world "
1
Every so often watch a video of a stage hypnotist just to be reminded of the power of suggestion.
3
An especially important component of kindness for doctors is a willingness to listen to others and to humbly consider that they may have useful information. My mom recently was at the eye doctor and informed him that she was allergic to iodine (which wasn’t in her chart). The doctor assumed she was wrong and gave her the drops, causing an allergic reaction. Social skills not only make patients feel better, but they lead to better science. The whole point of the scientific method, after all, is trying to find out whether we might be wrong.
14
This concept—developing a genuine, kind, and caring relationship with other people—is fundamental to success in all areas, from politics, to child rearing, to business, to medicine. As a small business owner, I’ve developed relationships with all my employees based on kindness, listening, fairness, logic, and integrity. I have found that employees who have these kinds of relationships will work harder, be more collaborative, care about others, are very loyal during difficult times, and generally are more successful. I equate these successes to the power of healing from a kind and reassuring sentence from a doctor.
24
Last week I went to see a new neurologist, my fifth in seven years. "Oh, you'll love Dr R!" exclaimed the receptionist at the clinic. A medical assistant added, "Dr. R is the best - so nice, such a great listener!" A few minutes later, his nurse said the same thing: down-to-earth guy, great listener. I started to get nervous - why is no one mentioning his brilliance, his experience? Then I realized: It's only the unusual that people find worthy of comment.
10
Nice, thoughtful, engaged people broadly succeed better at most roles and all involved seem to do better than the reverse persona. As a physician, such an individual prompts better patient, engagement, history and compliance with therapy, at the same time reducing risks of legal action in untoward outcome. Sooner or later though, the most humane and caring doctor, cannot escape the gravity of competence.
10
Very nice article that makes a lot of sense. But where do you find docs like this? Everyone would be trying to get an appointment with them....unless you are able to pay for executive medicine services. Where I have to go to get to see someone, I imagine it’s very hard to be kind and attentive if you’re only allowed about 10 minutes on average to spend with a patient. But on the other hand you do get a lot of post visit lab tests...some of which can actually be helpful.
1
@Donald I'm very lucky: Now with a new neurologist (see two comments above), *all* my current docs are kind and attentive -- even my adored surgeon, the other specialty traditionally known for being jerk-infested. And no "executive medicine services" required; in fact, I'm on Medicaid. I guess it's something in the New Orleans water?
3
I have had excellent care both at Northwestern University Hospital in Chicago, and at Mayo Clinic, in Rochester Mn. I feel my doctors, and nurses, are both competent, and caring. I am linked to both medical centers by computer. If I have questions or concerns, I can send them updates any time. I make a practice of sending questions to them before a visit, if I have any. It makes my life and theirs easier. I also send thank you notes!
I am on Medicare, and it works to perfection!
4
Having encountered a judgemental, dismissive new primary care doctor who had been recommended to me, and realizing that she actually left me feeling stressed, when I had initially been happy to meet her, I stopped seeing her and went directly to specialists who might be able to help me.
I happened to be much luckier with them, and, yes, they all showed that they cared, listened. One in particular, elderly, head of his department, told me that he didn’t mind the cold of Boston, in spite of being born in Florida, because he loved his job! When was the last time I had the sense that any doctor enjoyed his/her job ?
8
@lm...yes, I had that doctor and it was a she...she told me on a visit, if you don't listen to what I have to say, don't come back...was getting ready to request another doctor, when I found out she was closing down, she didn't tell me, I heard 2 of her nurses talking about getting jobs.
Ok so I tested this out recently by hiring a new primary care physician after growing suspicious that my primary primary care physician had grown too comfortable with my set of conditions, and had effectively normalized me in a kind of socio-medical way. In other words, my ailments were mostly of the neurotic nature and their bodily manifestations were more products of existential terror than anything that warranted "medical" attention. So I of course went to zocdoc to hire a good, popular, SEOdified doctor - who got rave reviews and was handsome, digitally. And he was physically handsome, too, and very warm and seemingly competent in practice as a professional person.
He also sent my blood out for excessive, expensive labs I didn't ask for, offered me anti-depressants without doing a psych evaluation (I declined), gave me lots of strange advice he'd probably gotten from Men's Health, and generally condescended to me as Gen Xers do to Millennials. In part I signed up for the condescension, but I can't lie - at the end of the appointment and for weeks after I felt well... well. Relieved. He reassured me. But did he do anything for me, medically? No.
I'll be going back to my funny, cantankerous, curmudgeon of a doctor the next time I find a lump in my bodily cavities, and love the attitude that is most definitely not "engaging" and "warm" in the conventional, banal sense.
4
Another benefit, this one to providers, particularly those in primary care:
Patients who "like" their doctors, who conclude the doctor cared, spent time, and was engaging, even when results are negative or less than anticipated, are far less likely to pursue formal complaints and/or malpractice claims.
These relationships are more difficult to actuate given newer realities of medical practice and imposed time constraints.
One solution is to employ medical scribes, enabling more provider/patient interaction and connections. Such individuals helped enormously in my emergency medical practice.
6
Hospitals and clinics rely on census. It's all about numbers. What if doctors, nurses, and psychologists just staged a coup? Lock up the administrators, take away their phones, their computers, and their devices. Totally ignore them.
Otherwise, it's efficiency--more computers, more telehealth, less interactions.
2
The commodification of medicine would not work if doctors refused to play along. They feel powerless. So where does the power lie? Follow the money to insurers and Big Pharma's doors. I feel sorry for the doctors and their patients. Between them and us lies a vast conspiracy to dehumanize medicine purely for profit.
And we need more studies to prove that humans benefit from being treated like humans? If this is not self-evident, what is? I cannot believe people here defending the idea that we are not the best evaluators of our own health outcomes.
We need politicians to fix the system, but people need to fix their brains on the idea that human emotion (e.g. what we feel about our own health) is both valid and valuable and does not EVER need to be quantified to be respected.
15
The article confirms what many of us in the medical community have suspected or heard anecdotally for years. Nice is a LOT easier for the doctor too as it takes much more effort to act cold, aloof and uncaring. I'm lucky to be in a sub-speciality where I have plenty of time to talk to my patients. My colleagues in busy primary care practices unfortunately are in a bind because they can't earn a reasonable living without seeing upwards of 10-12 patients per hour in some cases. 5 minutes is rarely adequate to connect with a patient who is anxious or in need, but the American Health Care System isn't adequately organized or funded to make it possible to take the necessary time and still be reliably paid. TIme for a single payer system that can accomplish BOTH.
40
@Danny
I am in Canada which has a single payer system. GP's are not adequately paid. Many try to take the necessary time to interact with patients, but 10 minutes isn't usually enough. What's worse, there aren't nearly enough GP's in any province. Many people are without one. If you mange to snag one you won't be able to shop around if you find he/she is incompetent or lacks bedside manner. Beware what you wish for.
2
It's so true that a warm reassuring doctor can promote your well-being.
I spent 10 years seeing a doctor at a city hospital, because of financial need. He was so cold, impersonal, domineering, overly aggressive in diagnosis/treatment, painting a dire future, and never once said I was "doing fine."
I had nightmares before each appointment, and was clinically depressed for weeks afterwards.
On the other hand, occasionally dealing with a warm and kind doctor was a godsend.
13
All I want is a doctor who knows what they are doing and pays attention to the patient in a polite and professional way. That is it.
Most are abrupt, rude, callous and indifferent. They have to move on to the next patient
7
This phenomenon has been studied heavily for decades in different ways. A doctor who patients perceive as “caring” has better outcomes than doctors perceived as not caring.
9
@J Rickert Same for real estate agents, teachers, carpenters, grass cutters, etc. People who like and enjoy their work and take pride in their work always favorably impress the customer. Only arrogant doctors think they are the exception.
1
Ask nurses...this is how we have always practiced!
39
@Deborah M_B
I have just returned from a 2-week hospital stay where I almost never saw a doctor, empathetic or otherwise. Instead I was cared for by nurses and "techs". Understaffed and overworked, a few of them were true angels of mercy whose attentions left me feeling more comfortable and optimistic. Unfortunately, a significant number were indifferent, cold, neglectful (45 minutes+ to respond to bell), and a few were downright rude and hostile.
4
As a Midwestern-born professional writer and daughter of a physician, I take issue with the adjective "nice." To my mind, "nice" conjures up a willingness to lie for convenience's sake. This is not a quality desirable in anyone, let alone a physician. What we want are _kind_ doctors.
9
@Anna What a ridiculous analogy to make - that being nice is akin to lying! I don't know what kind of environment or situation equates niceness to lying for the convenience of the moment but you're really off base on this one. While I understand doctors sometimes have to give difficult news to patients and it is not easy - but lying is unacceptable in any situation and I would be extremely dissatisfied with any professional who did.
1
@Gillian, I know exactly what Anna means. The key clue for me is "Midwesten-born". In my case it was Dayton, Ohio. In that part of the world, unlike in the greater NYC metro area, the social convention when interacting with casual acquaintances is niceness to the exclusion of frankness. My thought has always been that is the result of the near much higher likelihood of re-encountering that acquaintance there than here.
1
@carol goldstein You're right. Midwesterners are very nice, but not always very honest, and are more likely to tell you what they think that you want to hear, rather than God's honest truth.
4
While a good bedside manner is always nice, even better have doctors counterbalance our de facto criminal health care system.
What I mean is a doctor should be able to give both sides of the story to the patient ie the current de facto criminal party line for profit to patients for more visits, useless Tess, drugs, procedures, operations and the other side saying when the former will do more harm than the latter.
6
Doctors are just overwhelmed and loaded with
patients. The quality of care diminishes with quantity.
17
I just have to wonder if the power of caring and empathy have been discounted because these are considered feminine.
20
Nice article. As a physician, I believe that our job is to support the patient to heal herself or himself. This is distinguished from the health care provider providing the solution and the patient being a relatively passive participant in the process. By providing connection and reassurance, the patient's ability to participate in that process and lower their own stress, is much better.
28
During my cancer diagnosis and treatment I was fortunate to have doctors who could relate to me on a human level. My ENT/surgeon and radiation oncologist were personable and kind, and I developed good relationships with them both. Later I needed the services of a GI, and my ENT found me a gem of a doctor. He performed many throat dilations and a few colonoscopies for me, and although we didn't spend a lot of time together as I had with the other doctors, he had a friendly, kind demeanor and I felt very well cared for.
My primary care doctor, who also sees my husband and our daughter who has disabilities, is also a gem. How lucky we are!
21
I am a retired lawyer who dealt with medical malpractice cases as a staff attorney in the court system. Doctors who are nice to their patients are less likely to get sued - whatever the result of a treatment.
40
@MSL - NY As a retired nurse, I can say that I observed this too. The doctors who were sued were not less competent than those who weren't, but less personable.
9
@MSL - NY Is it possible to teach 'niceness' or caring?
How many of today's doctors got into the practice of medicine for a paycheck, and not because they care about or want to help people?
3
The other aspect is patients are likely to talk more frankly to a doctor they feel comfortable with, making diagnosis better.
36
When we lived in Seattle years ago my family had the best doctor, a general practicioner. He happened to be extremely personable, and competent, and funny. We adored him. I miss him, now that I live elsewhere. I remember I used to think: whatEVER he had to tell me about my health, even if it were bad news, I don't think I would mind that much--that's how much I trusted the character of that doctor and the warm sweet human being he was. He was totally on my side.
25
I thought this was common knowledge? I work with graduate students in health care and for the most part they understand the concept of being present or attending to their patients through effective communication, which means eye contact, effective communication (active listening skills) and observation, and asking open-ended questions. It's hard to believe that there was a study that has maybe proven what in my opinion effective health care providers have known for centuries.
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@Hopie
Effective communication is a skill; conveying genuine caring is a trait that used to be valued in medicine, as in some other professions. Just like house calls, now we are supposed to send photos to our "nurse practitioners" through our phones. All in the name of efficiency. Telemedicine in a developed country is unconscionable and just another way of dumbing down a previously enriching profession and our culture.
8
No physician (like me) would dispute the conclusion that a kindly, positive relationship with the patient can have a positive influence on recovery. Unfortunately, the experimental design used here makes this study a poor source of the "proof" it claims.
A histamine-provoked itch can easily be ignored or overcome by an act of will or suggestion, just as one can refuse to scratch an itch.
The findings of this study cannot be extrapolated to recovery from a serious illness, injury, or operation, where the pathophysiology is far more complex, and requires real mobilization of the body's physical defenses.
I don't doubt that psychology is important in serious illnesses also, I'm merely saying that this study doesn't prove it.
18
All good practitioners of medicine have known this, and effectively utilized it for patients' benefits, for millennia!
I learned early on in medical school that a friendly, and trusting, relationship between doctor and patient is probably the most important factor in good medical practice.
I made concerted efforts to follow such a path during 40+ years of solo private dermatology practice.
It was wonderful for me, and excellent for my patients.
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@Bob
And why would anyone do anything else? As if being human were a choice...? I guess I simply don't get it.
3
In my recent experience with surgery, the kind and caring doctor has all but disappeared for medicare surgical patients who "qualify" for the 'Medicare Bundle'. This is a new approach by Medicare and the medical establishment to force people into a treatment program that gives them as close to no time with the doctor as possible and the rest of the time a "team" of strangers streams through the hospital room handling the necessities (one hopes) but completely fails to deliver adequate and compassionate care to the recovering patient. After discharge, you are mostly on your own, and according to a new study by Goldwater et al, the result is a significantly heightened susceptibility to adverse events referred to as posthospital syndrome (PHS). A kind and present doctor could greatly alleviate the broad range of medical maladies which result from the stress response following surgical trauma.
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@Meighley This appears to be the case for simple 'wellness' care too.
Except for a primary care doctor, one amazing assistant and pleasant ever changing people at reception, the 'team' serving older patients at my new 'healthcare provider' could care less about patient health: at best they appear to be trying to prepare patients to get some major illness.
At worst, a few are racists more interested in their next vacation or curtain fabric update than patient health.
1
I recently met with a urologist to discuss what to do as a result of my PSA test. Six years ago it was 4.2. Five years ago it was 7.2. After both tests a biopsy showed no cancer. A recent test was 7.1. The urologist opened the consultation by saying I had to get a biopsy because my recent test showed a jump of 3 points. I told him that was incorrect, that my most recent test showed a slight decline. He insisted he WAS correct! I explained the sequence of the the three scores. He looked at my chart and said, “Oh, you’re right!”. I don’t expect a doctor to be my friend. I do expect them to listen and not tell me I’m wrong about my own health history. I chose to get another biopsy and have a very low grade cancer. The question in my mind is whether I have confidence in this doctor to listen to me going forward. He’s the professional. I’m not! Maybe he was having a difficult day when we first met. But when I read doctors commenting here that all that matters is competence, I wonder how they define competence. Scientific knowledge matters. So does listening.
44
I'd search for a different doctor were I you. Good luck. Prostate cancer is typically very slow to progress.
8
The ability of doctors to be present emotionally with our patients is undermined by dehumanized corporate procedures. Robo calls and faxes from pharmacies bombard us most days, though the majority are inaccurate refill requests that only generate confusion. Prior authorization demands from insurance companies intrude at times when we are doing something that is actually important, like managing a patient's crisis or spending time with our own families. To the extent that business management continues to be allowed to dehumanize and abuse doctors, people will not feel cared for, and whatever healing effect can be attributed to actual "care" increasingly will be lost.
42
@B Scrivener No one can dispute what you state in your comment. My doctor told me several years ago that 70% of her time was taken up with paperwork. This leaves a measly 30% of her time to devote to what she actually trained for: patient care.
When you have interference from PBM's like Express Scripts, whose sole purpose appears to be to deny patients their meds and to harass doctors, patient care can only suffer.
It's up to the doctor to compartmentalize these distractions and offer their patients uncompromised, superb care. It can be done.
It's up to the public to demand the removal of middlemen from healthcare and allow doctors to return to what they do best, caring for patients without interference or distraction.
33
This is an excellent article and is extremely important.
I did a lot of research before I chose my PCP. I wanted a physician I could trust and who would listen to me. I chose wisely and have nothing but the utmost respect and admiration for my doctor.
This past summer, my research and trust paid off big time. My doctor saved my life.
A caring, informed and trustworthy doctor is of extraordinary importance. This connection can both save and extend life.
Never underestimate the value of common kindness and caring.
34
@Pamela L. You were either lucky or sufficiently diligent to have found a doctor whom you could "trust and who would listen to [you]" and who saved your life. They don't always come in the same package. You did not describe what "a lot of research" consisted of and what other criteria you might have used. That might be helpful to others.
NOTE: One website lists 303 doctors in Family Medicine within 5 miles of Burbank, CA. I trust you did not interview all of them.
3
@Peter Wadsworth I was both lucky and diligent. I chose the best health insurance plan available to me and within their catalog of PCP's, I did my research on each doctor.
When I met my doctor, I knew instantly that I had made the right decision. She compiled a complete medical history, was kindness personified and very compassionate. You can't fake these things.
It's not just a case of reading about each doctor, looking at Yelp reviews, or looking for malpractice information or lawsuits. It's also about a gut feeling and how the doctor interacts with the patient.
My doctor, Dr. Angela R. Adelman, an internist and gerontologist, has something very special. She goes above and beyond for her patients and was obviously born to be a doctor. Her caring comes from deep within her soul and I owe my life to her.
I can only hope you're as fortunate.
9
There is one thing long forgotten in medicine today. Love. If a doctor loves his patients they will always do the right thing; be it to encourage, scold, console, refer, maintain skills, and know what one doesn’t know.
19
@Peter Casale. "Scolding" a patient is unprofessional, disrespectful, and inappropriate.
2
@Peter Casale, I don't expect my 5 Doctors to love me nor all their patients. My primary care doctor is outstanding but I don't expect or even want him to love me.
1
Research and analysis by McKinsey & Company, Consumer Reports, the Boston Consulting Group, the University of Michigan and other organizations reveal the need for better internet-based consumer information and consumer awareness:
Consumers often rely on patient surveys to choose a PCP, but those surveys don’t measure quality and remain of questionable value even after 10 years of compilation.
Consumers barely mention hospital or medical group affiliation as a basis for choosing doctors.
The article "Healthcare Consumerism & Outcomes: Opportunities for Improvement" (LinkedIn July 18, 2018)
addresses this issue in much more depth.
@Peter Wadsworth--After I was treated for cancer I looked up my doctors on several ratings sites and was flabbergasted. I loved my doctors, and found them very personable, caring, and willing to spend time with me. I can only conclude that the patients who go to the trouble of rating a doctor are the ones who think they have some kind of beef. I'll not rely on those sites to choose a doctor.
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@Susan
These type of surveys treating physicians (and lawyers, etc.) like a restaurant in a Yelp! review is essentially meaningless. Physicians and surgeons survive based upon their reputation and that reputation best comes from word-of-mouth by friends, family and medical colleagues who have interacted with that person.
People make their judgment on several criteria: empathy, compassion, skill, availability of time and the ability to not only listen to but hear the patient's complaint. Always choose the recommendation of a family member, close friend or trusted physician over any of the these reviews on a website.
7
"We found that having a doctor who is warm and reassuring actually improves your health. The simple things a doctor says and does to connect with patients can make a difference for health outcomes."
If "health outcomes" are measured by the patient's verbal *report*, all this may show is that when a doctor is nicer, the patient is primed to put a positive spin on the doctor's efforts. But is there evidence that a doctor's niceness improves health when health is measured in a way other than by the patient's say-so?
6
I am a physician myself and have gone to doctors who are extremely friendly and others who are cold fish. All I really care about is competence. I'm not looking for a friend; I'm looking for someone to care for me.
I try to adjust my style to the patient. Some prefer me to treat them like a friend; others prefer the Dragnet "Just the facts" approach. I'm happy to the best of my ability to be what they prefer.
I should also add that I am somewhat skeptical about the view that patients' beliefs in the efficacy of a treatment is a major factor in whether or not they benefit from it. I perform acupuncture and I've never seen any difference in benefits from it between those who come to me with a firm belief it will help and those who are skeptical about how sticking needles in them can help.
7
Seriously? You do acupuncture and you haven't noticed a difference in outcomes? I think you're not looking closely enough.
7
I don't mean to denigrate palliative care during the recovery process. But there is no substitute for proper diagnosis and treatment. Someone who is a star in the hospitality industry would not necessarily make a good diagnostician or surgeon.
Consumer's Checkbook rates surgeons based on outcomes and other doctors' recommendations. Clearly those are more important criteria for serious illnesses than how "nice" the doctor is.
But perhaps this is a false choice. Diagnosis, treatment and aftercare almost invariably involve a team of doctors and healthcare professionals, each with different skills and personalities. That is why medical group practice, hospital affiliation and coordinated care are invaluable.
8
So true, that your tone of voice matters in all aspects of life, especially in a doctor's office, where we're often more vulnerable and scared than in other aspects of life. When anyone says, "Sit down" in a comforting tone, it's more reassuring than when someone barks, harshly, "Sit down!" I even wrote a book about doctor/patient interactions called, "What Patients Want: Anecdotes and Advice." Thinking about this article, it reaffirms the idea of a mind/body connection. If you're reassured, I think your body and your mind respond in kind, to kind words.
15
Perhaps this is also a lesson for our everyday interactions. How we treat people matters, not just in medicine but in life.
106
"Cure sometimes, treat often, comfort always" is a quote attributed to Hippocrates. True 2000 years ago. Still true today. Those of use who have been in practice for years know that empathy is a powerful therapeutic tool. Genuine concern for the person sitting in front of you creates the therapeutic relationship that is critical for successful treatment. Knowledge and technical skill are prerequisites but empathy is the capstone in the arch of treatment.
58
Some people - including some Doctors - create more tension in others - which is going to work against many treatments, and also to create a barrier that can interfere even with the patient being able to HEAR the content of, say, instructions on diet, or medications or surgical aftercare.
Those who maintain an unfriendly exterior often do it, unconsciously, because it protects themselves from having too much contact. And for all, there must be some barriers. But unconscious barriers can create added tension for the Doctor as well. This itself can lead to underlying anger which seeps through in edginess and impatience.
I've been blessed with an internist who is in the 99+ rank in both professional skill and caring.
It isn't necessary to be that perfect, but to find a way to be tuned into the patient.
One thin I was taught, just as a social workers, was that even a small touch can alleviate your own discomfort in some situations and can communicate a connection to the other person.
One of the constant complaints registered in Times columns is that many "exams" take place with almost no touching in modern medicine. Some believe it is necessary for the general art of diagnosis; perhaps it is a major part of creating a trusting connection? Not without all of the other skills, but in combination.
10
@cheryl
Being touched as part of an exam differs from other unnecessary touching in a doc's office, even if it is supposedly well-intentioned. For example, survivors of childhood physical abuse can find such non-exam-related touching frightening and inappropriate.
@Bokmal
Agree with you, it is within the appropriate boundaries - and that means finding out if the patient is alright with it and/or - when certain steps are absolutely needed, letting the patient know what is you are going to be doing, step by step.
3
A very timely article. My partner was just released from the hospital after what was to be a simple surgical procedure. He landed in the ICU, where the "team" rounded daily, checking his charts, speaking to the nurses, but never talking to him. Not once. He was disappointed that his voice was neither sought nor heard. Then his oncologist, someone who has cared for him for 11 years, surprised him with a visit, helping to put the experience in context and reassuring him that he'd be ok. That one visit, personal, warm, professional and reassuring did more to help him than the expertise of the ICU "intensivist/experts" who never laid eyes on him
93
Shame on the ICU team.
6
@Ellen Empathy. I wonder if med schools are selecting for -- or at least teaching -- empathy? Is it naive to think Empathy can be taught?
3
Maybe some of what happens when a doctor is warm and caring has to do with trust. When we trust a doctor, it also helps us to heal. So kind words and warmth promotes trust which can allow our body to relax and believe the doctor will help us.
As a psychotherapist I know all my kind words and warmth will not matter if my patient is unable to trust me.
54
@BSR--Trust may be the most important thing. When you trust your doctor you hear what is said.
4
For routine medical exams and minor issues, the doctor's positive and pleasant bedside manner is a great plus and makes the experience that much better. But when a serious medical condition arises, you can be sure that I am focused on the expertise and capability of the doctor. Anything more than that is certainly welcome, but medicine should still be a place for the best and brightest in that field.
10
@Lee Del
Unfortunately sometimes that outlook encourages some professionals to think that competence gives them a pass to be cold, rude, and dismissive. It’s not OK. How often is the very best guy or gal that much better than the second best that it makes that kind of treatment worth it?
7
Thanks for the affirmation of my style of practice. I fully endorse it and recognize the benefits of connecting to patients. I have practiced primary care for over 30 years and my patient experience scores on surveys have always been excellent. The fact that I graduated from an Ivy League college and Med School, certainly is reassuring for patients but many of them don’t know my credentials but trust me because of that connection. The relationship I have with my primary care patients, is one of the most important in their lives and I remain humbled by this reality and committed to trying to provide them with the highest level of medical care.
77
It’s unusual to hear a caring person in any walk of life to pat him/herself on the back.
9
Thanks for the affirmation of this style of practice. I fully endorse it and recognize the benefits of connecting to patients. I have practice primary care for over 30 years and my patient experience scores on surveys have always been excellent. Many of my patients do not know that I went to an The fact that I graduated from an Ivy League college and Med School, certainly is reassuring for patients but many of them don’t know m credentials but trust me because of that connection. The relationship I have with my primary care patients is one of the most important in their lives and I remain humbled by this reality and committed to trying to prove
9