In an essay in today’s NY Times, (http://www.nytimes.com/2011/11/01/health/views/the-downside-of-doctors-who-feel-your-pain.html?ref=health) cardiologist Lisa Rosenbaum asks whether “nice” physicians really provide better care than those who are merely technically competent. In this context, “nice” involves interpersonal relationship skills like physical proximity, eye contact, empathy, acknowledging patient concerns, and asking about feelings. Certainly these skills will make the physician more likeable to most patients, but will it improve their care?
Dr. Rosenbaum observes, “…we have no data to suggest that medical students who sit close but not too close make any fewer mistakes than their less-communicative colleagues. The awkward student in the corner who obsessively follows a checklist may make fewer procedural mistakes than his charming friend who lights up the room.”
This discussion misses what patients yearn for—not so much likeable doctors, but doctors who can ameliorate their suffering while treating their physical disease. Niceness doesn’t treat suffering, and empathy only begins to treat it. Admittedly, both suffering and its effective treatment are objectively unmeasurable, but that’s no reason we physicians shouldn’t either learn how to do it or assign the job to someone who can do it. Instead of teaching medical students how to maintain eye contact or how close to sit, we should be showing them how to listen for elements of suffering in order to draw it out and be comprehended so it can be acted upon. But that’s an art, meaning it takes time, and this sort of profound intervention is not medically reimburseable.