By Evan Falchuk

My post What Really Matters provoked a lot of interesting responses from doctors and others.  But especially doctors.

In my post, I said that what patients really want from their doctors are three things:  that their doctors pay attention to them;  that they answer their questions;  and that they give them the confidence that they’re going to do the best they can.

A round-up of the very insightful reactions is below.

In the comments, Dr. Val Jones, of Better Health Blog (and ABC News television) fame, responded:

What really matters is that doctors would probably do this instinctively if they were paid the way lawyers are – for their time. Not to be flippant here – but it makes a big difference to social graces. Most of what we do is undervalued, over papered, and part of system that makes us miserable.

We are constantly pressured to work for free – that’s why docs don’t like to do email or phone calls with patients, even though it’d be in their best interest. We don’t see our loved ones, kids, own families – because we’re staying up late coding, buffing charts, and playing “mother may I?” with insurance companies.

Now, that doesn’t excuse bad behavior – and doctors should spend more time with patients, getting them the answers they deserve, and treating them with kindness and reassurance. But asking them to do all that for free is something that all but the saintly-est will struggle against. That’s the real problem here, IMO.

As an attorney, I am not sure if I should be pleased or worried that a doctor says the social graces of lawyers are something to which doctors can only aspire.  I’m pretty sure I should be worried.

Dr. Robert Centor, who has written extensively about bedside manner, attentiveness and thoughtfulness in medicine wrote about my post, saying that quality health care isn’t about performance indicators, it’s about things like those three rules:

Our bedside manner really matters. Patients brag about their physicians when those physicians follow these 3 rules.

We must teach this to trainees. We must live these rules ourselves.

Dr. Michael Kirsch, of the MD Whistleblower blog, turned his reaction into a blog post, asking Where Have All the Bedside Manners Gone? Dr. Kirsch gives some good explanations, like Val did, for why the relationship between doctors and patients can become strained.  And he finishes with a plea to patients to recognize their role in making things better:

Despite these distractions, physicians should provide patients with the care and attention they deserve, even though this task is harder than ever. Ironically, we physicians increasingly feel that no one is giving us care and attention. We’re not getting it from the government. We’re not getting it from the insurance companies. We’re not getting it from the press. We’re certainly not getting it from the legal community. Our patients may be our last best hope for showing us some understanding. This gesture would revitalize us and shake off the demons. Then, we could try a little harder to give you Marcus Welby, M.D. instead of Dr. Gregory House.

Meanwhile, Gregg Masters, uber-health care blogger, commented:

I believe one of the conclusions reached at the Mayo Transform symposium was that ‘conversations’ (and high quality ones at that) are what differentiates Mayo from the rest of the pack. Better conversation more often than not leads to better data, which in turn drives better choices, which generally influences better outcomes. Bottom line, better conversations = better health care. I believe its Maggie Breslin’s pitch: http://centerforinnovation.mayo.edu/transform/.

Also, I once heard in another setting that: ‘listening is an act of love’. What else need be said?

Indeed, Gregg.

Finally, in a possibly related post, Dr. Bryan Vartabedian of 33 Charts writes about the 3 Questions that Complete a Medical Interview.

Understanding where the parents are at is critical to both understanding a child’s problem as well as pitching a plan of care. Whether it’s revealed to me or not, parents often come to me with an agenda. If my plan doesn’t meet with their view of the situation, it’s going to be much harder for me to help that child get what she needs.

You’ll have to go to 33 Charts to find out what those three questions are, and read the whole thing.