Etiquette-Based Medicine: Should Etiquette Trump Compassion or Empathy?

Writing in the May 8 2008 issue of the New England Journal of Medicine , Michael W. Kahn, M.D., a professor of psychiatry at Harvard Medical School expressed his thoughts regarding his own doctor “’What a professional,’ and even (unexpectedly),’What a gentleman.’" Here is the extract from the article where Dr Kahn explains his conclusion.

Patients ideally deserve to have a compassionate doctor, but might they be satisfied with one who is simply well-behaved? When I hear patients complain about doctors, their criticism often has nothing to do with not feeling understood or empathized with. Instead, they object that "he just stared at his computer screen," "she never smiles," or "I had no idea who I was talking to." During my own recent hospitalization, I found the Old World manners of my European-born surgeon — and my reaction to them — revealing in this regard. Whatever he might actually have been feeling, his behavior — dress, manners, body language, eye contact — was impeccable. I wasn't left thinking, "What compassion." Instead, I found myself thinking, "What a professional," and even (unexpectedly), "What a gentleman." The impression he made was remarkably calming, and it helped to confirm my suspicion that patients may care less about whether their doctors are reflective and empathic than whether they are respectful and attentive.

I had never heard the expression “etiquette –based medicine” but it appears I have been teaching my first and second year medical students exactly that and more of what Dr. Kahn sets in the article regarding his checklist for etiquette behavior towards the patient. I find that my medical students are if not already imbibed with etiquette are easily taught and responsive. My guess is that later in their medical careers as they get more patients to care for within a limited time available and have conflicts of interests between patients and with their own personal non-professional lives, full etiquette behavior by some gets tossed aside. Unfortunately, many patients can sense this loss and this can explain why they are apprehensive or unhappy with their doctors. However, somehow I would still put compassion and empathy on the top of the list of a doctor's worthy behaviors. To me etiquette behavior is in a way “just acting a role” whereas true compassion and true empathy are not acting but feelings by the doctor and is the stuff, beyond the doctor’s skills, that makes the doctor-patient relationship most meaningful. What do you think? You can read the full free article by clicking on the above link. ..Maurice.