Archive for » November, 2013 «

Caring clinicians

A colleague, whose views I respect, said at a recent meeting of medical teachers that he’d rather be treated by an unfeeling doctor who cures him than one who is kind and sensitive but fails to treat him competently.  This argument appeared to convince the group that we should not spend much effort on how to address values among our medical students and concentrate instead on improving their technical competence. I did not object at the time because I did not quite realize that we were being led quietly astray (although not as a result of the speaker wanting deliberately to mislead us).

The clinicians present at this forum were individuals I’d without hesitation consult, if I needed treatment for a disorder relevant to their specialty, because they are all competent. And nearly all of them are kind, polite and caring. Asking me to choose between the competent but rude doctor versus the polite but useless one is a strategy that deceives. The competent ones are nearly always to be found among the caring and polite and the bunglers frequently among the rude and swollen-headed. It does not, of course, follow that all caring and polite doctors are competent.

Why do caring and competent doctors function as apologists, as seen in this instance, for the generally rude bunglers? The major reason is probably that it is in their nature. The nice ones, being nice, don’t want to show up the awful ones for what they are. So they cover up for the nasty characters. But they do great damage in the process. It is part of the responsibilities of concerned professionals to ensure that their colleagues are good enough to belong to the club. By covering up for the bad and the ugly, the good ones contribute to bringing standards down.

A second possible reason is that good doctors see some dreadful colleagues who rip their patients off, whilst posing as kind and concerned. So the quietly competent may have become suspicious of superficially charming tricksters among them, whom the public loves. The really good doctors cannot outdo the smarmy rogues, in apparent concern and caring. So they may have become rightly suspicious of those who pose as caring. But this is to confuse pretence with the real thing.

Competence and efficiency correlate strongly with kindness and caring. The question for those who train doctors, and for the public who are at their mercy, is not whether we want doctors who are competent as opposed to caring. That dichotomy is unreal. The real issue is about how we ensure that all doctors are at least passable on both counts. And this is something medical teachers cannot do, without getting the patient public involved.

The public too has to be given the means to judge the competent from the incompetent. At present they have only doctors’ manner and reputation on which to base their decision. So they are induced to consult the more reputed or trendy and probably more likeable individuals. Adequate information to make educated selections among doctors or hospitals is not available to the public. A measure of caring for patients is the trouble the doctor takes to give them the best possible deal. We must start arming the public with the capability to decide which doctors and hospitals give them a bad deal and which a good.

 

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