Wednesday, June 13, 2012


A friend went to his doctor for a bone marrow biopsy. Since this means punching a small hole through the pelvic bone, he was anxious. The doctor, preparing his equipment and probably meaning to lighten the atmosphere, said, “Don’t worry, I’ve done one or two of these before.”

My friend told me, “Sure, I knew he’d done plenty before. But this was my first, and his joking only added to my anxiety. And when I left, he said, ‘I don’t think you’re going to die anytime soon.’ I hadn’t asked him that, so why did he bring it up? Don’t doctors think before they speak?”

I hear this sort of complaint from patients weekly. As I’ve written before here, we’re impressively advanced in technology but the lowest-tech aspect of our craft, communication, is often lacking. I encourage patients to give their doctors feedback—to point out where they could improve and also praise them for communicating well. Most do that, usually by snail-mail letter. If they don’t provide feedback, there’s no mechanism within medical practice that informs docs about their behavior with patients.

You'll no doubt be surprised to learn that even I have received critical letters and irate phone calls. Believe me, I’ve paid them attention since they indicated a shocking discrepancy between the saintliness I assume about myself and the way others sometimes see me. So I know feedback works, but I ask myself how we can insert some preventive medicine here—improve doctors’ communication before the train wreck.

It’s a difficult business, though, for a couple of reasons. First, when no one’s told us otherwise, we naturally believe we’re doing well, so we don’t need, say, a communication workshop. And second, doctors absorb their profession into their self-image more than most others do. Medical training isn’t limited to learning medicine; it simultaneously imparts an implicit course, How To Be A Doctor (which, by the way, doesn’t include communication skills). In training and practice, doctors learn a special outlook and language, what to say and how to say it, pertinent gestures, what to wear, what to avoid. They tend to stick together socially, and to value views of fellow members over those of outsiders. So criticism of any part of a doc’s performance is ego-threatening. I’m not saying improvement in medical communication is therefore impossible, only that to be effective it must be done with finesse and compassion.

If you accept that this is the case, how would you educate practicing docs?


  1. I may be a bit of a contrarian here, Jeff. It seems to me that what one patient may dislike, another may like. We can't be robots, although I did have a neurology attending that would give Startreks Data a run for his bedside manor :-)

    The other thing I've seen is where the patient's report of the doctor's behavior and words has been inaccurate.

    Like any other arena, I think most of us are really trying to do the best we can in this changing medical field of ours.

  2. Hi, Dr. J,

    Discovering delicious individual differences is one of life's joys. The tool for doing that is listening.

    I agree that we docs are doing our best. So are patients. To assume that virtually everyone is doing their best is a potent vitamin for compassion, especially compassion for ourselves. Given that, now, today, can I do a little bit better than I did yesterday?

    - Jeff