As a long time practitioner and medical school faculty, I have spent endless time on this. Much of this harks back to the "The top third of the class does the best research, the middle third make the best clinicians, and the bottom third make the most money" adage for medical school classes: the bottom third generally had the most/best …
As a long time practitioner and medical school faculty, I have spent endless time on this. Much of this harks back to the "The top third of the class does the best research, the middle third make the best clinicians, and the bottom third make the most money" adage for medical school classes: the bottom third generally had the most/best interaction and made patients feel like they cared.
Making a patient feel like you care is an art form that is virtually never taught any more -- to the greater detriment of doctors and patients. And this gets worse, sadly, as most physicians now become employees of organizations who have great lip service about patients, but who fundamentally actually do not really care about any individual patient.
IT/EMR solutions which are NEVER patient-oriented (I can (and do) write books about this) suck valuable time away from patient interactions in the service of lawyers and documentation without value. Performance metrics based on throughput more than quality (the most abused term in health care) do not help either.
Finally, the recruitment of current students is only making this worse. There was a time when students were admitted to medical school because they were smart and they had a burden to do the best thing toward making people "get better". Now admissions are based on demographics and social justice warrior scores. Those SJW scores are all for some "cause" -- not for the patient sitting in front of you now. Because of the deprecation of admission criteria, we now no longer test students adequately (it is all pass/fail and people do not fail) to see how good they are at ANYTHING -- it is not hard to pass since no one wants to be stuck remediating these people and the boards are now pass/fail anyway so they will get through there, too. Students insist on "knowing the test questions" to make their lives easier -- even though the point of the test questions is to make sure you know THE MATERIAL so that you can APPLY IT TO REAL PATIENTS -- not to answer the test questions. But that sense is lost and/or they do not care.
These students (and I have been doing this for decades) are also characterized by having a disproportionate number who are mostly worried about their OWN life/health/balance/whatever -- not their patients'. This transition to self-focus (and I do not mean self-introspection) also deprecates the patient interaction as students/house staff walk out of the room when their "shift" is up, irrespective of the condition of the patient or the process.
So this is about more than placebo effect -- this is more the "caring" effect and it matters. Kudos for pointing that out in this article. But somehow we need to do more. Some of us try, but it seems too little, too late.
Thanks for your thoughtful read and response. I had forgotten about:
"The top third of the class does the best research, the middle third make the best clinicians, and the bottom third make the most money"
I think I learned "The top third of the class gets elected AOA, the middle third make the best clinicians, and the bottom third make the most money" but this never really made sense to me given the difficulty of matching into some well-payed specialties.
While it is true that CV and neurosurgeons (and spine orthopods) categorically make the most, their numbers are deliberately and artificially limited which is part of it...not to take away from the technical skills of the really good ones.
But I remember as a medical student a general internist, "Dr. Smith", who always had a whole unit of the hospital filled, and a patient panel three times the size of anyone's. Patients would get up at 4:30 in the morning to primp for him so they looked their best when he made rounds at 6:00. He was an OK doc, but the best patient-relator I have ever seen...he cared, they knew it, and that, coupled with decent medical knowledge, made him not only well respected but, I am sure, better compensated than the super surgical specialists.
I found it amazing that he was so loved by his patients and learned more from watching him than almost anyone else I watched. He also never wore a white coat (at a time when EVERYONE always wore one). After desperately working to reach the point where I could wear a white coat (which took several years), I came to recognize that it took several DECADES to be able to take the coat off (if one ever reached that point) and to be known for who you were, not what your badge said. And he was a doctor who cared.
It matters -- to the profession, to how we educate and most of all, to patients.
As a long time practitioner and medical school faculty, I have spent endless time on this. Much of this harks back to the "The top third of the class does the best research, the middle third make the best clinicians, and the bottom third make the most money" adage for medical school classes: the bottom third generally had the most/best interaction and made patients feel like they cared.
Making a patient feel like you care is an art form that is virtually never taught any more -- to the greater detriment of doctors and patients. And this gets worse, sadly, as most physicians now become employees of organizations who have great lip service about patients, but who fundamentally actually do not really care about any individual patient.
IT/EMR solutions which are NEVER patient-oriented (I can (and do) write books about this) suck valuable time away from patient interactions in the service of lawyers and documentation without value. Performance metrics based on throughput more than quality (the most abused term in health care) do not help either.
Finally, the recruitment of current students is only making this worse. There was a time when students were admitted to medical school because they were smart and they had a burden to do the best thing toward making people "get better". Now admissions are based on demographics and social justice warrior scores. Those SJW scores are all for some "cause" -- not for the patient sitting in front of you now. Because of the deprecation of admission criteria, we now no longer test students adequately (it is all pass/fail and people do not fail) to see how good they are at ANYTHING -- it is not hard to pass since no one wants to be stuck remediating these people and the boards are now pass/fail anyway so they will get through there, too. Students insist on "knowing the test questions" to make their lives easier -- even though the point of the test questions is to make sure you know THE MATERIAL so that you can APPLY IT TO REAL PATIENTS -- not to answer the test questions. But that sense is lost and/or they do not care.
These students (and I have been doing this for decades) are also characterized by having a disproportionate number who are mostly worried about their OWN life/health/balance/whatever -- not their patients'. This transition to self-focus (and I do not mean self-introspection) also deprecates the patient interaction as students/house staff walk out of the room when their "shift" is up, irrespective of the condition of the patient or the process.
So this is about more than placebo effect -- this is more the "caring" effect and it matters. Kudos for pointing that out in this article. But somehow we need to do more. Some of us try, but it seems too little, too late.
Thanks for your thoughtful read and response. I had forgotten about:
"The top third of the class does the best research, the middle third make the best clinicians, and the bottom third make the most money"
I think I learned "The top third of the class gets elected AOA, the middle third make the best clinicians, and the bottom third make the most money" but this never really made sense to me given the difficulty of matching into some well-payed specialties.
While it is true that CV and neurosurgeons (and spine orthopods) categorically make the most, their numbers are deliberately and artificially limited which is part of it...not to take away from the technical skills of the really good ones.
But I remember as a medical student a general internist, "Dr. Smith", who always had a whole unit of the hospital filled, and a patient panel three times the size of anyone's. Patients would get up at 4:30 in the morning to primp for him so they looked their best when he made rounds at 6:00. He was an OK doc, but the best patient-relator I have ever seen...he cared, they knew it, and that, coupled with decent medical knowledge, made him not only well respected but, I am sure, better compensated than the super surgical specialists.
I found it amazing that he was so loved by his patients and learned more from watching him than almost anyone else I watched. He also never wore a white coat (at a time when EVERYONE always wore one). After desperately working to reach the point where I could wear a white coat (which took several years), I came to recognize that it took several DECADES to be able to take the coat off (if one ever reached that point) and to be known for who you were, not what your badge said. And he was a doctor who cared.
It matters -- to the profession, to how we educate and most of all, to patients.