Bioethics Discussion Blog: Etiquette-Based Medicine: Should Etiquette Trump Compassion or Empathy?

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Sunday, May 11, 2008

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.

9 Comments:

At Sunday, May 11, 2008 1:51:00 PM, Anonymous Kacy said...

Why do (some) people have to complain about their doctor because he she don`t smile etc. My doctor is my mentor my friend all in one. Without his care my body would not be quite as painless as it is at present.

 
At Sunday, May 11, 2008 2:43:00 PM, Blogger Maurice Bernstein, M.D. said...

Very good question, Kacy. It could be that some patients find it easier to simply look at the gross appearance of their doctor rather than critically analyzing the more subtle and subjective reactions and responses as the relationship continues. ..Maurice.

 
At Sunday, May 11, 2008 7:30:00 PM, Anonymous Anonymous said...

I have recently had a series of encounters with medical professionals who were rude -- not apologising for long waits, talking to me as if I were a three year old, that sort of thing. From my perspective as a patient, etiquette training would be a good start -- I simply don't think it is possible to enforce empathy, but if I felt at least respected (if not cared for) my visits to doctors would be less distressing.

--PG

 
At Monday, May 12, 2008 10:19:00 AM, Anonymous bob koepp said...

I think it's obvious that each of us would strongly prefer that our physicians behaved toward us as if we were deeply loved and highly respected old friends. That would be nice. But if I had to choose between 'nice' and 'skilled' I wouldn't waste a second pondering which way to go.(I know a surgeon who's an arrogant ass -- in spades! But if I needed some delicate cutting done, I'd trust him with, well, my life.)

 
At Monday, May 12, 2008 11:25:00 AM, Anonymous lady patient said...

One thing curious about one of my doctors is that in the 2 years that I've been seeing him, (he's my oncologist) he has never greeted me by name. In fact, I have never heard him say my name even when giving instructions to the nurse regarding my care. I've been tempted to bring this to his attention, but didn't want to embarrass him.

I'm not offended in anyway, but I do recall reading somewhere that for practical reasons it's a good idea for the doctor to say the patient's name at the beginning of the appointment in the off-chance he might have brought in another patient's chart by mistake.

This doctor, in his 60's, never rushes his appointments, encourages me to ask questions....he has so many pluses, in addition to my complete confidence in his abilities. I'm very fortunate. But I'm trying to figure out if not greeting me by name is deliberate. I can only imagine cancer doctors, who lose so many of their patients, might just be trying to protect themselves emotionally by keeping their patients at a distance.

 
At Monday, May 12, 2008 12:09:00 PM, Blogger Maurice Bernstein, M.D. said...

But Bob.. can you divorce sugical skill from personality? For example, could arrogance. an unwise personal attitude carried to inter-personal behavior, be reflected in unwise aggressive technique while cutting through human flesh? What I mean, is that arrogance, which is a form of overbearing pride, be expected to influence a surgeon's decision to operate, to the selection of a technique and to his (or her?) response to a intraoperative complication? Or, as I saw happen when I was an intern rotating through surgery at the operating table with a distinguished orthopedic surgeon who in personal anger threw the scalpel across the patient's body and narrowly missed the intended target, a nurse. The scapel, I remember, also narrowly missed innocent me! I would be cautious being attended by an "arrogant ass" of a surgeon. ..Maurice.

 
At Monday, May 12, 2008 12:25:00 PM, Blogger Maurice Bernstein, M.D. said...

Lady patient, your last sentence is very insightful and for all I know may be a correct interpretation of a behavior which more likely could be attributed to oncologists. ..Maurice.

 
At Monday, May 12, 2008 12:38:00 PM, Anonymous lady patient said...

Dr. B., I have read so many accounts of surgeons throwing things at nurses during surgery (see Allnurses.com). Isn't that an assault with a dangerous weapon? What is it that can make a surgeon so angry to do such a thing.

 
At Monday, May 12, 2008 2:03:00 PM, Anonymous bob koepp said...

Maurice - As far as the surgeon in question is concerned, I probably wouldn't take his word for it that surgery was necessary. After all, if you're holding a scalpel, the world tends to look like something that needs to be cut. But if I had already satisfied myself that surgery was in order, I wouldn't hesitate to ask him to do the deed.

 

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