GREAT BEDSIDE MANNER DOES NOT NECCESSARILY MEAN SKILLFUL DOCTOR

As illogical as it may sound,  choosing a doctor based on his/her kindness and great bedside manner is not always the smartest decision– this is advice coming directly from two kind doctors.

One of the two doctors is the author of a highly recommended read: Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care, by Marty Makary, M.D. The other was one of John’s own doctors. More on that later.

Makary drives home his point with a story of two senior doctors from his time as a young resident. Once you hear the nicknames given to these two, you will never forget the illustrative story– promise. The residents referred to the pair as The Raptor and The Hodad.

The Raptor was like a bird of prey, feared for his rapacious attacks on his hapless resident victims. He was blunt to the point of verbal abuse, prone to screaming and completely insensitive to the feelings of others. This behavior was unfortunately not confined to just junior doctors; he  was rude and brusque with patients and their families as well, an equal opportunity insultor. Given a choice, no one wanted him as their doctor. He was, however, a brilliant surgeon. He was fast and efficient and his technique was impeccable. He never made a mistake. No doctor in that large hospital had a lower complication rate.

The Hodad, on the other hand, was every patient’s dream doctor. He was genial and kindly, a great listener with a kind word for everyone. His patients worshipped him. But his hospital nickname was an acronymic tell-all: Hands of Death and Destruction. He was an inept surgeon with one of the highest complication rates in the hospital. He had poor judgment and practiced outdated medicine. He was infamous for operating on patients who didn’t need surgery. But even the patients who had been victims of one of those disasters still wanted him as their doctor because he was such a nice guy. No one wanted The Raptor.

This story rings especially true for me– because John had a Raptor-like colon surgeon. I’ve described in other posts how he totally came unglued and started screaming at the top of his lungs at me on our very first meeting, right after John’s near-death emergency surgery. “Hostile” would be a massive understatement. A complete asshole. When it came time for John’s reconnection surgery, we went to the Chief of Surgery, who had filled in for the Raptor on one of John’s post-surgical checkups. This guy was one of the kindest, gentlest doctors you could ever hope to meet. His genuine compassion towards John brought me close to tears.

So we showed up in his office and told him, “We want you to do this surgery. We can’t stand the Raptor and his rudeness.” His response totally caught us off guard. He said that he would be happy to do the surgery, but that he would advise us that this was NOT a good decision. He understood about our reaction to John’s previous surgeon, and confided that we were certainly not the first patients to feel this way. He told us that this rude doctor was “the very best we have”, that he was an excellent surgeon who did nothing but colon surgeries. The chief, on the other hand, was a general surgeon and did way fewer colon surgeries. It came down to a simple choice: the most skilled doctor or the kindest doctor. He told us that he would go with whatever we decided, but that he felt that it was important that we fully understood the parameters of our decision. We ended up biting the bullet and going with the Raptor.

Which doctor would you choose?  Based on likeability alone,  almost every  patient would choose The Hodad. But what if patients had access to information on the doctor’s performance record, just as we as consumers can learn virtually everything about any one of hundreds of thousands of  products by reading buyer reviews on Amazon? Did you know that hospitals already have all of this information in their database, about every doctor in their system– but  that doctors’ performance records  are carefully kept from the public? If you knew that the doctor you were considering to do your surgery had a miserable track record and a high complication rate, would  that influence your choice?

This kind of transparency in the medical field is exactly what Dr. Makary,  colleague of  The Raptor and The Hodad, is strongly advocating. But, since we do not have that option at the moment, he did add one intriguing additional suggestion about choosing a doctor: when faced with  unclear or vague symptoms with no clear diagnosis, this is the time when the best doctor is the one who has the patience to sit with you and ask many questions without getting frustrated. This is the time for a kind and compassionate doctor who is able to look at the facts from many different angles while remaining calm and determined. A Raptor-like doctor would be a nightmare diagnostician. But The Hodad wouldn’t be much better, since he had a history of making bad decisions.

Again, I can speak from personal experience. When I had my own disturbing health issues in the last year of John’s life, I found myself in the hands of an incompetent doctor with no patience, no compassion, very little in the way of diagnostic skills and a very disturbing fascination with inserting various probes into many openings in the human body. I was dangerously close to becoming a victim.

How does the average patient sleuth out the good doctors? Makary suggests that asking a nurse is a great way to start. Medical personnel who work with doctors know who is good and who is not. The key question is: would you want this doctor to operate on you? In retrospect, had I paid more attention to the ever-so-subtle facial expression of John’s GP when I told him I had chosen the demented doc described above, I would have known that this doctor did not have a stellar reputation among his peers and that the GP’s answer to this question would be a resounding “no”. But that was a time when I knew far less than I know now.

May our own hard-earned knowledge and the wise advice of Dr. Marty Makary empower your own medical choices. May all future patients benefit.

 

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About surfingon

I live in Hawaii. I surf in the winter and swim in the summer. I have been a hospice volunteer with a contemplative-care oriented hospice for 25 years have been part of their team that trains new volunteers for the last 9 years. I have walked the colon cancer path with my beloved husband these past 5 years. He died very peacefully in April 2009. I now seek to share what we learned, to shed light on the many dark corners of this often mystifying, heartbreaking and heart-opening journey.
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One Response to GREAT BEDSIDE MANNER DOES NOT NECCESSARILY MEAN SKILLFUL DOCTOR

  1. Carol Shutt says:

    I always look forward to your blogs, Rachel. I learn so much from you. -Hope to see you again in the not-too-distant future. Who knows when our paths will cross again. -Be well, Carol

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