Can a doctor have a good bedside manner and be medically competent? That is the question. In my experience, these two things rarely go together. This is a shame because I consider them two sides of the same coin when treating patients. You can’t just be good at one of them and expect to get the best possible outcomes. And I’m not the only one who says this, research bears this out as well (see more below). So why do doctors who are clinically competent rarely have a good bedside manner and vice versa? Do we really have to choose between the two?
A Doctor’s Bedside Manner
Bedside manner is medically defined as:
“The attitude and conduct of a physician in the presence of a patient.”
When I talk about having a good bedside manner, what I mean is that a doctor possesses an attitude and conduct that facilitates positive and useful communication and feelings between the doctor and patient.
According to the paper, “Physician behavior and bedside manners: the influence of William Osler and The Johns Hopkins School of Medicine,”
“Patients bring fear, anxiety, and self-pity into the exam room. It has always been the doctor’s responsibility to calm their fears and provide hope. The accomplished doctor has a bedside manner that is humane and compassionate, empathetic and supportive.”
I would say the words “humane,” “compassionate,” “empathetic,” and “supportive” are great words to describe a good bedside manner. I also think those are words that many of us wouldn’t use to describe our doctors. And when it comes to psychiatrists specifically, I suspect even fewer of us would characterize them that way.
Does a Doctor’s Bedside Manner Matter?
Some might think that a doctor’s bedside manner is just to make patients feel warm fuzzies and that doesn’t dictate the outcome of their treatment, so clearly, that’s less important and doesn’t really matter.
Well, if you think that, you’d definitely be wrong.
For example, in a review of clinical trials in 2014, it was found that:
” . . . a doctor’s bedside manner can greatly impact patients’ health, aiding their efforts to lose weight, lower their blood pressure, or manage painful symptoms.”
The UCLA Geffen School of Medicine also notes that:
“Bedside manner among all medical professionals is a crucial part of their patients’ recovery . . . The ultimate goal of any encounter is to promote trust and healing. How physicians, nurses, social workers and even housekeeping approach patients and their families can directly affect the overall experience for patients and their willingness to learn. With good bedside manner, providers are ultimately able to improve communication and reduce errors.”
And yes, all of this impacts outcomes. People who feel more positive about their doctor and the interactions with their doctor have better treatment outcomes. (See here and here.) In short, a doctor’s bedside manner isn’t just about feeling warm fuzzies but it’s actually about getting the job of helping a patient done better.
A Doctor’s Medical Competency
When I talk about a doctor’s superior clinical competency I basically mean they are superior at diagnosing and treating patients. I suspect every doctor thinks they have superior competency but this, of course, isn’t true. Just ask patients — or other doctors. Some doctors have radically better clinical outcomes than others. I tend to say that patients need to find a match between themselves and their doctor in clinical approach. But, the fact of the matter is, some doctors just shouldn’t be seeing patients at all. I wish a neon sign would help us identify them.
A Doctor’s Bedside Manner vs. Their Medical Competence
Truly, the most competent doctors I’ve ever seen could not be described as humane, compassionate, empathetic, and supportive. They just couldn’t. I’m not saying doctors like that don’t exist, but I am saying they are a rare breed. I remember writing about an incredibly competent psychiatrist — her peers rating her as #1 in the area — as having the bedside manner of a lamp post — cold, hard, and unforgiving. That typifies my experience with those types of doctors.
I think that competency and bedside manner fight each other in a doctor’s psyche and life. For example, if a doctor is spending all their time on researching conditions (which is great for competency) they may start to lose sight of the people behind those conditions (terrible for bedside manner). Focusing your consciousness only on diagnosing illnesses and appropriate treatments starts to make the world (and a patient) look like a petri dish. That’s just kind of the nature of the beast.
Similarly, I think it’s hard for someone who truly is humane, compassionate, empathetic, and supportive to have the clinical distance required to make the best medical decisions, particularly given that many medical treatments are awful, especially in the beginning. If you have a great bedside manner and you see things from the patient’s perspective, you may not want to do things that will be perceived as hurting them.
So, to me, it seems like a tug-of-war of priorities.
And I’d also like to mention that the psychiatrists, for example, who treat the hardest cases also have the highest risk of something terrible happening to their patients. For example, a patient dying of suicide. This can impact a doctor tremendously, particularly if they really did care for the patient in the first place.
Choosing a Doctor’s Medical Competence or Their Bedside Manner
I’m a very difficult case of bipolar disorder. In my many years of treatment, I’ve been sick more often than I’ve been well and treatments frequently do not work. So, I’ve always chosen medical competence over bedside manner. I figure no matter how awful they are to me interpersonally, I can deal with that more than a doctor making less-than-ideal decisions. But, as I mentioned above, bedside manner really does matter in treatment outcomes too, so maybe I’ve placed too much importance on one side of the equation over the years.
What would be better, on my part is to find a doctor that has both a good bedside manner and superior clinical competence. In other words, I should search for the holy grail.
Alas, I am not Indiana Jones, so that is a pretty tall ask.
One thing to keep in mind is that young doctors may be better at bedside manner because they just got out of a program that emphasized it (many do) and they aren’t burned out yet, but unfortunately, a young doctor is unlikely to be able to treat a very complicated and difficult case of serious mental illness. I suspect the opposite is also true. Many doctors who have been practicing for years have greater clinical experience on which to base their decisions but they’re often overworked and overburdened and the first thing to go seems to be bedside manner. (Also, you can’t get sued over a bad bedside manner.)
So, the answer? Technically, no, we shouldn’t have to choose between a doctor’s bedside manner and their medical competence. Doctors truly should provide both. Medical schools should create doctors that care deeply about both.
But this is reality, here. So many doctors have god complexes. So many doctors want to assert dominance over their patients. So many doctors appear to not care about you or what happens to you. Dealing with them is like wading through a minefield.
So, the real answer? Try to find a doctor with a reasonable combination of both. I’ll always lean towards the superior medical competency side, but that’s me. You lean your way. Just be aware that both sides of the coin matter when it comes to your treatment outcome, and that’s what matters most.
Image by Flickr user Vic.
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