Sunday, March 1, 2009

Etiquette-Based Medicine

Here is an article by Michael Kahn, MD published in the New England Journal of Medicine, May 8, 2008 about "etiquette-based medicine." I wonder if you have to choose, will you want a doctor who is polite but poor in his or her clinical skills or one who is very competent but poor in manners? Of course we know all doctors are both polite and competent...

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.

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