Wednesday, October 15, 2014

Technical skills versus bedside manner

English: A thoracic surgeon performs a mitral ...

Let’s assume you need to have cardiac surgery and you have a choice between two cardiac surgeons – one whose complication rate is 10% and the other's is 5%. The one with the lower rate is known to be a jerk who is rude and takes money under the table. The other one is a thorough gentleman. Whom would you pick ? And why ?   When you're selecting a specialist , should you choose one who's technically extremely competent ( but rude) , or one whose bedside manner is excellent ( but whose technical skills are not as good) ?

In a perfect world, all doctors would be both technically superb as well as deeply empathetic . This is the ideal combination which all of us are looking for in our doctor ( and if you're lucky enough to find a specialist who has both these skills, count yourself extremely lucky , and hold on to him for dear life ).

However, it's extremely rare to find this kind of doctor , and this is why patients are often forced to choose between technical competence and bedside manner . This is a complicated issue  - and there is no easy answer. Everyone makes a different decision, and the answer depends on the kind of patient you are , and what kind of medical problem you have .

Lots of patients are quite happy to settle for a surgeon whose technical skills are superb, and they do not care much if he provides any hand-holding afterwards, as long as he is a technical wizard in the Operation Theater. Others will focus on the doctor’s bedside manner. Their belief is that the technical skills most doctors have is similar; and they use his bedside manner as a surrogate marker for his medical skills, based on the assumption that if he has taken the trouble to cultivate a good bedside manner, he will be professionally competent as well.  They will refuse to go to a “star” surgeon who is rude, because they feel that a doctor who does not respect his patients is not a professional they would be willing to trust. They believe that it hardly matters whether the hernia surgery takes 10 minutes or 15 minutes – how could this affect wound healing ? As long as the doctor is proficient , they would rather have someone they can talk to, who will be there to hold their hand after the surgery, rather than someone who's just a technical wizard .

There will be others who will say – What do I care if he holds my hand after the surgery, as long as he does a superb job in the OT ! This is why patients will often have such diametrically opposite opinions about the same surgeon. Some will swear by him, while others will swear at him !

Ideally, doctors who had good technical skills would also work on polishing their bedside manner , because they understand the importance of both of them. This is the hallmark of a really great medical professional , but if you cannot find a doctor who has this rare combination , then you are going to have to select which of these two is more important for you. An enlightened doctor will understand his weaknesses and will try to correct them by employing juniors who have complementary skills. Thus , a senior surgeon may employ juniors as assistants and delegate the job of talking to patients to them.

Remember that there are no right answers – it’s just that you need to be clear in your own mind as to what’s more important for you, so that you can find the doctor who is right for you . The chemistry between doctor and patient needs to be right,  and this is extremely important . Patients need to understand that they often have a choice in the matter !

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