We need to stop treating technical adeptness and the ability to understand and communicate with patients as a zero sum game.
I once fired a doctor for her lousy bedside manner. She was technologically advanced and scientifically up-to-date; her exam and waiting rooms were lovely; the front office staff was friendly, helpful, and efficient. But she was unable or unwilling to answer questions, address or allay fears, and treat me with compassion.
Last Sunday’s New York Times featured a story on the Association of American Medical Colleges’ (AAMC) revision of the MCAT, so that it now incorporates “squishier” subjects including social and behavioral sciences and medical ethics. When AAMC’s president, Darrel G. Kirch, announced the changes, he said:
“[In surveys,] the public had great confidence in doctors’ knowledge but much less in their bedside manner. The goal is to improve the medical admissions process to find the people who you and I would want as our doctors. Being a good doctor isn’t just about understanding science, it’s about understanding people.”
But a response from MedPage Today’s ‘Dr. Wes’ claims that this is preparing medical students for “a health care world that will not exist.” He goes on to say:
“Developing selection criteria for medical school based on social and humanitarian coursework without addressing the reality of today’s increasingly computer-screen-focused medical practice is whistling in the dark. As it is developing today, the AAMC would be more effective by preparing students with typing lessons and pre-selecting them for unflagging conformity and rule-following skills. ... If the AAMC is truly concerned about patient-centric medicine, it would promote student activism to participate in policy changes that insist on more patient contact.”
I find it ironic that he chastises this effort as creating “unflagging conformity and rule-following” while encouraging the AAMC and students to lobby for more rules to follow. Instead of training physicians to assess a patient’s emotional and psychological needs and respond accordingly, this approach encourages another layer of bureaucracy, another box to tick, without regard for how each physician interacts with the human sitting in front of them. My former doctor could have checked the ‘patient contact’ box, but she still didn’t understand people.
All medicine is, essentially, intimate. Even in the best case scenario-a healthy patient undergoing an annual physical-a patient is submitting his body to a virtual stranger. But this intimacy is especially profound in obstetrics and gynecology. When a patient doesn’t feel heard, when she feels judged or embarrassed, she just wants to get out of that office as quickly as possible. If that happens, physicians lose the opportunity to ask and answer questions, to clarify, instruct, and explain. They lose the opportunity to help a patient heal and be healthy. They lose the opportunity to do their job.
We need to stop treating technical adeptness and the ability to understand and communicate with patients as a zero sum game. I hold no illusion that pre-med students enrolling in medical anthropology courses will solve this issue, but at least it acknowledges that there is one. And that’s an important first step.