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Medical Information: Is the Bedside Manner Important in Modern Medicine?

Nicholas V. Costrini, M.D., Ph.D.
Medical Director
Georgia Gastroenterology Group, PC
I was at a dinner party recently and overheard the following conversation. The intelligent looking lady to my left said, “I saw Dr. Smith because of his reputation as a brilliant neurosurgeon. He may be God’s gift, but his bedside manner is horrible. I wouldn’t let him operate on my goldfish.” A quiet, sweet-appearing woman across the table chimed in, “My Doctor Bob is not very smart, but I like going to him because he listens and cares about me.” Physicians just love to be at dinner parties like this one. I was so aggravated by the end of the meal that I became queasy and almost lost my crème brulee. I had been able to smile rather vacantly at the ladies while I inducted them into the Society for the Preservation of Insults Against the Medical Profession. I had done an honest days work and had tried to be pleasant, caring and competent at what I did for the benefit of my patients and my professional pride. I had raced home, dressed for dinner, and arrived a bit late because of loose ends at the hospital (a patient in shock, I think) only to hear in casual dinner conversation that a physician may be the Christian Barnard of the world of surgery or the internist for Larry, Moe and Curly and it doesn’t matter. According to the dinner crowd, what you really need to be a successful physician is a great show of being all warm, fuzzy and sincerely interested in your patients. I thought to myself, “Oh sure, ladies. Just show up in the ER tonight with crushing chest pain, a kidney stone, or a red-hot appendix. If Attalla the Hun and Hannibal Lecter arrived with MD degrees from Harvard Medical School, you would let either of them take care of you faster than I could say “HMO”. All this stuff about bedside manner is not worth the price of an aspirin when a patient is really sick. While smiling and sipping coffee, I defended Dr. Smith by thinking, “I’ll bet he was up all night with a brain tumor case and was dead tired when the genius with goldfish walked in with a migraine. No wonder Dr. Smith was brief, formal, and not particularly empathetic. While munching on an after-dinner mint, I thought about “Dr. Bob.” Such doctors are pleasant, but dangerous. Good-hearted and kind Dr. Bob is likely to misdiagnose or miss altogether the breast cancer, thyroid nodule, or Crohn’s disease. Bobby may or may not be sued, but he certainly should be shot at dawn by my newest officer of the Georgia Medical Society, the Terminator. His duty is to seriously shorten the careers of the “Dr. Bob’s” of the world. As I finished the mint and coffee, my wife suggested it was time to leave. I could barely tear myself away.

Such dinner party conversation is commonplace. What then is the value of the doctor-patient relationship? There is good evidence that being an empathetic and friendly physician capable of presenting even difficult medical advise in a positive and supportive manner is likely to produce a better medical outcome than the formal, reserved, and impersonal consultative effort many patients have experienced. A friendly and positive manner and style of care, however, must not be allowed in lieu of competent medical care (i.e., Dr. Bob) but rather in support of it. Business schools and medical schools have distorted the whole issue of the doctor-patient relationship by suggesting that the patient is first and foremost a consumer or customer. Physicians offer a product, but patients require much more than a pill that fits well. At the University of Arizona medical students study horse body language to hopefully learn a more effective bedside manner. Soon enough, some U of A graduate will toss a rope around a patient’s neck and take her to the OR for a hysterectomy. I just love medical educators. The doctor-patient relationship is an ever-changing and unique cultural entity requiring medical, social, and communicative skills on the part of not only the physician but also the patient. To make the relationship even more complicated, both the neurosurgeon and the ladies at dinner are only human. Let’s do lunch and practice a little medicine.

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