What you want in a doc: Kindness and compassion, or skill and brilliance?

In general, when dealing with life or limb-threatening health issues (e.g. treatment of cancer, heart bypass surgery, etc.), would you rather be under the care of:

  1. an immensely kind, compassionate, and understanding doctor, who takes the time to answer your questions (and makes sure you understood the answer), and who you find comforting, patient, and reassuring, but whose medical/surgical skill is about average, and maybe even slightly less?

OR under the care of one

  1. with an unsurpassed record of medical/surgical brilliance, “the top person in his/her field”, but who is rude, condescending, impatient, pained to answer your questions, and who you feel probably views you as nothing more than “a case of X” or that “new BMW he’s had his eye on”?

Clearly these are exaggerated stereotypes, but there may be more than a bit of ‘real life’ applicability in these characterizations (IMO).

In a while, I’ll tell you my choice and my rationale for it.

Definitely 2. In the situation you have posed, I need someone skilled, not someone to hold my hand. I can get moral support elsewhere if I need it.

Life or limb threatening?

Give me nasty but brilliant every time.

ETA: I want House.

Even for regular checkups, I don’t like doctors who try to comfort me. They aren’t my friend. I come to them for their knowledge and skill. However, I would have a big problem with a doctor that won’t answer my questions. I chose #2, assuming that he will answer questions, just with attitude. If he won’t indulge questions at all, I’m back to #1.

The best doctors are both…yada yada yada…and if your surly guy is driven by money, it is highly unlikely he’s also a brilliant physician. You have to be passionate about the job to get to the highest skill level because performing at the top level means that’s where your energy, time and commitment are focused. Doesn’t mean he doesn’ love being rich; just that it’s not a principal driver.

Once you made the condition life-threatening, no knowledgeble person would choose the friendly average guy. As a (fellow) physician I see who we physicians choose when we are seriously ill, and it’s not the guy who got into Med School under some borderline candidate policy–it’s the brightest we can find.

You know the caveats as well as I do. Dr Feelgood Friendlyspeak might uncover the problem in the first place, b/c he takes the time to find out about me. And (s)he’s the one I want taking care of me on a regular basis where the medicine is easy and the communication skills are more important than the rigor of decision-making ability.

But when I’m sick and I need Fancy Care? Only one standard: Outcomes when delivering Fancy Care. Intelligence when I need Fancy Decisions. Good hands when I need to get cut on.

A brief but illustrative story from my training:
We had an attending who was widely disliked by us Medicine Residents. Demanding. OCD. Bit surly. One day one of us had a sick dad. Sent him to that guy. We all asked why. “Because my Dad’s sick. I need the best guy.” Stupidly obvious.

One last thing. One of the great things about being a doc is knowing who is good and who is not. Over the years I’ve seen some fabulously incompetent physicians go a long way with a silver tongue and a good bedside communication skills.

I will write more in the morning, but it is amazing to me to see the cutting criticisms leveled at the “rude and uncaring” on the various ‘rate your doctor’ sites. In many instances, I read how people scathingly put down a doc because ‘he made me feel rushed’ or ‘he didn’t look me in the eye’. Yet, I know for a fact that some of the doctors being criticized are brilliant, brilliant people when it comes to delivering - in the clutch, or at leisure. My point is that although people think they don’t care, and claim they don’t care, about a docs ‘personality’ or ‘style’, as long they’ve got the ‘best’, they often do care. Loudly. Even when they’re with the ‘best’. In the trenches, it seems, people want more than intellect or talent.

I also don’t think that, in many cases, there’s nearly the difference people think there is between the skill level of the ‘best’ and the ‘average’. Often, at least in Internal Medicine, my field, what makes much more of an impact, is time. How much time the doc allows him or herself to think about the problem, the dilemma. In 95 percent of the cases, it’s not hard at all to do what’s best - IF you take the time to do it. “Brilliance” is not the critical ingredient. Not at all.

(And please note, no where I am equating ‘average’ with incompetent, or with those who succeed on charm and personality. Where I come from, ‘average’ is good.)

I’ve worked with both. Bottom line is, live is short enough. I have enough friends, my doctor doesn’t have to be one of them.

Are people forgetting that the doc needs info, info s/he can only get from YOU, the patient? If they don’t have the wherewithall to buckle down and fake whatever demeanor will best get honest answers from their patients, they’re going to be lucky when they make the right diagnoses, not brilliant.

Ya need info AND brains. Two different skillsets; I don’t imagine they’re as commonly found together as one might wish.

Honestly, I think that certain doctors are more apt to make errors by being rude, pushy, short-shriven, and inaccessible.

Heh, this was one of the med school interview questions they love to ask to see you squirm and force yourself to pick a decision: “Would you rather be a doctor that is beloved by your patients and the community you work in” or “would you rather be a doctor that never made mistakes without any ability to deal with patients” and you had to pick between the two, no way to be both or to try to combine traits and say well it’s impossible to be absolutely one or the other…

And then within our first few weeks of med school they point out that when people/patients are polled on this very question: Do they want the most caring doctor or the smartest doctor, they’ll almost ALWAYS pick intelligence. Yet, it’s also the “smarter” doctors who are likely to be sued or hit with a malpractice suit when they err vs. a “caring” doctor that’s made several errors over the course of his career.
That’s the trade off it seems. Be right all the time and hope you never screw up, because if it happens you’re getting slapped with the lawsuit ASAP, or take the time to be caring and warm and hope that if you screw up, your patients are more likely to forgive you. And they never let you pick both on the interview question…

First of all, this is this an utterly false dichotomy: there is no reason why a doctor could not be both, or neither, or on any combination of intermediate points on either spectrum.

But even putting that aside, it depends very much on what the problem is. If I have an acute, life threatening disease that can be quickly cured after the right diagnosis and treatment, I want House. If I have a relatively common disease that can’t be cured, or for which the cure will be long, drawn out and unpleasant, then I want Wilson. If I am depressed, or have hurt myself in some embarrassing way, I want someone empathetic, and their medical skill won’t matter much.

I didn’t vote. There is no right answer.

I think that if I went to a doctor that was rude and pushy, I would think that he/she is not taking me seriously and is not going to treat me properly. I don’t know how I would find out that the doctor is the best doctor in the world or worst…until after they treated me and it worked or didn’t. How exactly am I to be reassured that the doctor is teh awesome?

If a brilliant jerk doctor can look at me and say “I know what your problem is and I know that I can fix it” then ok. But I never have those sort of problems. I can’t imagine being in that sort of situation.

What I want is a kind and compassionate GP who guides me through my basic problems, works with me to figure out a solution and knows who to refer me to when they don’t know the answer. The person they refer me to can be an asshole, but I would trust my GP to know that the asshole specialist is brilliant.

I visit regularly with a CNP in my doctor’s practice. I guess she technically is not as “smart” as the doctor seeing that her degree is less than his…but boy have I made progress health-wise with her compared to all my years of seeing him. He’s not a jerk but he’s a little rushed, and a bit of a pill pusher. With the CNP I get 30 minutes of quality time and we discuss how I can improve my health. With him I get 15 minutes if I’m lucky, admonishment for smoking and being fat. No shit sherlock - now what?

When I was about to have spinal surgery last year, the neurologist warned me that the neurosurgeon he was sending me to wasn’t exactly a warm and friendly type.

As someone said above, I’m not looking for a new friend. I want the guy who’s about to crawl into my spine to be the best guy in the state, never mind the best guy in town. I want to Google his name and find 20 years of ongoing research and writing of textbooks. I want to go to his waiting room and see people who flew in from other states to see this guy. So what it he has less personality than an IV stand?

This sounds like the classic situation in which I don’t care about personality; I want extreme competence. In any unusual or highly difficult situation I’d want someone at the upper end of the scale in terms of ability and dedication, warm fuzziness be damned.

There are plenty of other situations though, even “life-threatening” ones, where you don’t have to be a rocket scientist to prescribe/undertake the right treatment, and there I’d place higher value on being empathetic and encouraging (as well as listening to) questions. At the extreme of being “cold and rude” you risk missing out on the information that is essential to caring for your patient.

There are (usually) a lot of doctors out there who you can see. No need to settle for a lout.

A couple of other points:

No matter how brilliant you are as an M.D., you will make mistakes at some point. In medicolegal terms, the SOBs have an extremely small margin for error, in that a patient who’s pissed off at how they were treated is far more likely to sue such a doctor, compared to an M.D. who was nice and is perceived as trying hard to do the right thing.

Physicians themselves are loath to deal with fellow docs who are perceived as difficult. In residency, I recall a department meeting where we were considering what graduating medical students we wanted to offer upcoming residency slots. There was one candidate who was generally acknowledged as brilliant, but got pushed far down the list because he was perceived as being argumentative and hard to get along with. The doc who was most critical of him was also the biggest existing SOB in the department. And this was in Pathology, for crying out loud. You might think that if there’s any field in which you could get away with a bad personality, it’s Pathology. But you can’t dispense with people skills in any area of medicine, except possibly research. And even there you’ll do far better if you can suck up to the department head.

Also: some docs are a real pain to their staff/underlings/lab workers, but are nicey-pie to patients. If possible, these are also M.D.s to avoid, in that a work environment seething with resentment is probably not very conducive to good patient care.

I want to have the latter doc, but I want to be the former doc.

Well said, my friend.

I have little new to add. But I want to repeat that, from my experience and observations, although people claim to want “the top person”, in practice, they wind up complaining about that person’s “rudeness”, etc. The patient gets referred to “the top guy”, was forewarned by their GP, “hey, he’s a cold duck, but the best”, and often still comes away feeling hard done by after their visit.

On a different tangent, I, myself have had a LOT of surgery. Much, much more than most people have in (two) lifetimes, all done by the same guy. I remember when things started and I told my colleagues what kind of surgery I was going to have - without even pausing, many of them immediately offered words to the effect of, “Oh, you must be seeing Dr. ‘X’ for the surgery, no?”, with Dr. ‘X’ generally held to be the top guy.

But I wasn’t seeing X. I felt that the difference in technical skill between X and my guy was probably not all that great. More importantly, I liked my surgeon. He was a normal person; I could talk to him. I wanted someone who I wouldn’t be “afraid” to bother if I was concerned about something. As it turned out, I developed all types of problems as time went on, and each and every time my surgeon immediately accommodated me with whatever was required. I am certain that I would have either hesitated “to bother” X with some of my post-op symptoms (and we’re talking many operations in a few years), or he would have not been able to see me expeditiously (‘in Europe’, ‘away at a conference’, ‘lecturing in Prague’, and so forth). I would have lost time and suffered more. And I probably would have wound up switching to a different surgeon eventually using the diplomatic excuse that “given how busy you are, what with all your travel and commitments, etc.”

One last, semi-relevant note: When my sister needed the involvement of a particular subspecialty in her care, I could have gotten her in to anyone. There is no doubt that the “top guy” would have seen her if I asked. But the knowledge and skills required to meet her medical needs were not esoteric, in my opinion. So, I made sure she saw a nice, caring person who, no doubt, would be considered average in terms of medical skill. No problem. What was important, again in my opinion, was that she would feel comfortable with him.

I see I was one of the very few who voted for kindness and compassion over skill and brilliance. For me the most important component in the doctor-patient relationship is trust. It’s not just that the doctor has to know the right thing to do, it’s that I have to believe that she knows what she’s doing. I can’t trust someone who is arrogant, cold, or rude to me. It will affect my willingness to listen to that person’s recommendations, and make me less likely to do everything I can to fight for my health.

I’ve been putting off (non-life-threatening) surgery that has been recommended to me for months, and thinking about it now I realize that the primary reason is that the surgeon, a well-respected guy who is known for being one of the best in his field, is an arrogant jerk. While I might actually prefer to have him cutting me open, I don’t want to go see him, I don’t want to have to talk to him (or listen to him talk about himself and his brilliance – did you know that he developed the computer system used in his office himself?), I’m not sure I trust him when he says that no matter what anyone else might do or say, he’s the expert and he knows that I need this surgery. Not only that, but after researching another surgeon, I’ve put off arranging to see him because I don’t want to have to ask surgeon #1 for my records or tell him that I’m choosing someone else.

Even though this situation is non-life-threatening, I think it would be exactly the same if I were considering chemotherapy or open heart surgery. I need someone who can talk to me and make me feel better. I have had surgery once in my life. At that time I was given the choice of having the surgery “next Tuesday” or waiting awhile to see how the problem developed. I had no hesitation in choosing to have the surgery, because the surgeon was friendly and compassionate, and made me feel like she would do her best for me.

I do my research and make sure I’m dealing with someone competent who isn’t constantly being sued, but beyond that, I’ll take compassion every time.

I know some brilliant doctors with decent bedside manners who were still frequent targets for lawsuits because they took the tough cases. So that’s not always the best indicator of quality.

QtM, who’s been sued more than once now for allegedly violating my patient’s “constitutional right to be pain-free”.

I’m going against the grain and voting for kindness and compassion, based on my own experience and that of my sister.

Doctors who are skilled but rude, condescending and impatient tend to NOT LISTEN. And when they don’t listen, they may not make the right decisions about my care. My sister had, for the last 18 years, been in constant pain in her abdomen. She began diligently seeking medical help for it about 12 years ago. She saw many very smart, highly skilled and respected doctors, and their answers ranged from it being IBS to, literally, all in her head. She went through who knows how many different treatments, and all along, my sister had suggested that it might be endometriosis. None of them took this seriously until two months ago. This doctor finally agreed to do the laparoscopic surgery to see if that was what it was. After 12 years of being dismissed or improperly treated, my sister had the surgery and what did they find? Turns out her appendix had perforated 18 years ago, which had caused a lot of scarring and adhesions in her internal organs. The surgery wound up correcting much of the scarring and adhesions and now she’s no longer in pain.

I’ve personally been in a few situations where I was being seen by a highly skilled and respected doctor for things that were emotionally charged for me. While I didn’t need those doctors to be a new best friend, I did need them to be respectful. When I had what turned out to be an ectopic pregnancy that had ruptured one of my fallopian tubes, I was referred to a guy who was called the best sonogram guy in the state. I was told he’d retired from full-time practice and now all he did was perform sonograms and consult on them.

My experience with him was absolutely dreadful. I’m in a shitload of pain, grieving over this lost pregnancy, laying on my back with a huge wand shoved up my vagina, and hearing this guy say to the nurse, “What IS that? Is it a tumor?” He never once addressed me, never explained a thing, and shushed me when I asked a question. Then he left the room and it was the nurse who told me I needed surgery so they were calling an ambulance to take me to the hospital.

Thank goodness the doctor who actually led the surgical team was awesome. She was compassionate, patient, answered all my questions, explained everything before they began, and came to see me as soon as I was coherent again to talk to me and tell me what to expect afterwards. It made a huge difference to me to feel that I had an ally. There’s a difference between an ally and a “friend.” She made me feel that she had my best interests at heart and was doing everything in her power to help me – the whole me – not just my symptoms.