Heart Health


September 14, 2009


A degree an Ivy League institution is good, but is it everything?

A friend of mine and I were talking last week about his son—a bright ambitious high-school student—who is interested in the medical profession.  The question came up: how important would it be to strive for entrance into an Ivy League establishment for college or medical school?  After training is finished, how important is it to have that type of pedigree on your curriculum vitae?  This all led to the most interesting part of the conversation: Do patients really care?

The answer involves the fundamental question about what patients value in a physician.  Naturally, being the type of person who needs complex matters boiled down to inane simplicity, I quickly attempted to put together a list of the characteristics in a doctor that I think matter most to patients.

Before I start, however, you need to understand my inherent biases in this matter.  Being a doctor for 16 years I can no longer view the medical profession purely through the eyes of a patient.  Obviously, the best person to be writing this article would be a non-physician patient, preferably one with considerable experience (both good and bad) on the other side of the doctor-patient equation.  Secondly, my provenance is far from Ivy League.  My undergraduate degree (in German) was at Brigham Young University; I attended the University of Utah for medical school and residency (in internal medicine); and Uncle Sam gets the credit for my cardiology education (Wilford Hall Medical Center and Brooke Army Medical Center in San Antonio, Texas).  So you see, the closest I get to Ivy League is watching college football.

Here’s my list of what I think patients value most in doctors:

  1. Bedside manner, interpersonal relationship, and communication skills.  According to a survey from the United Kingdom cited on WebMD the most sought-after physician attributes are a “warm, friendly manner” and “a doctor who knows me well.”
  2. Accessibility.  The same study cited “short waiting time” and “flexibility in selecting appointment times.”
  3. Clinical competence.

Somewhere down the list falls “a diploma on the wall with an Ivy League school emblem,” probably right below “ruggedly handsome good looks” and just above “pleasant waiting room feng shui.”

Bedside manner and communication skills are a bigger deal than where the doctor went to school

I’m open to discussion about the hierarchy I’ve proposed, but I’d guess I’m right in putting “clinical competence” only third on the list.  I don’t think this necessarily means that the ability to successfully deliver quality care is less important than the warm and fuzzy manner with which the doctor tells you he incompetently screwed up your case.

Rather, it is the explicit recognition that modern medicine is far from perfect, that most diseases cannot be eliminated, and that people will continue to suffer and die regardless of what flashy new technology we develop.  In this setting what we want most from our doctors (or NPs or PAs) is a sympathetic expert partner to guide us through the minefield of aging and disease through which we’re all eventually going to have to pass.  Not even the most erudite academician can deliver surgeries with no complications, treatments with no failures, or medications with no side effects.  Bad things will happen to us all and we’d rather have a good doctor with a great bedside manner than a medical genius with the personality of a doorknob.

Or worse.  Everyone has heard horror stories of arrogant doctors who are just plain mean to people—doctors who berate patients and family members, who don’t bother to take the time or effort for simple politeness, and who become frighteningly defensive when a patient raises any questions.

Prior to coming to Nebraska I practiced in Ohio where I knew a renowned expert in the unusual field of adult congenital heart disease (people with birth defects of the heart who live into adulthood and are no longer best treated by pediatric cardiac specialists).  Only rarely did I have to send patients to him, but every time I did I knew what response I would get from the patient.  “I hated that guy!  He’s the most arrogant *%#!! I’ve ever met!”  Each time I had to apologize and explain that I sent the patient to him because of how smart he is, not because of how pleasant he is.   After a while, though, I just had to give up—his expertise was simply not worth the trouble.

In an ideal world, all doctors would be endowed with an approachable and humble bedside manner, and then we could comfortably place “clinical competence” at the top of the list.  Thankfully most doctors are both competent and considerate and thus rank high in both attributes (the “accessibility” issue is still one we need to work on).

As doctors we are required to complete a specified amount of continuing medical education yearly in order to retain our licensure.  We attend courses, read journal articles, and study textbooks to keep us well versed in the latest science our specialties have to offer.  Looking at ourselves from our patients’ point of view reminds us to spend as much effort honing our interpersonal skills as we do our clinical skills.

On another note, I had the pleasure of attending the American Heart Association’s annual Go Red For Women banquet last Thursday with my 7-year-old daughter as my date.  Several hundred women—all adorned in red—enthusiastically expressed their commitment to their own heart health and the health of those they love.  It was great to meet our BetterU bloggers in person and hear the updates they gave to the crowd.  My daughter enjoyed it, too.  But as someone who doesn’t need to expend much energy worrying about the well-being of her coronary arteries my daughter was really only impressed with the free feather boas given out after dinner.

  1. Arie

    Funny, this post had me thinking of House too. What I want in a doctor is a lot along the lines of your list, Dr. Van De Graaff. First and foremost, I want someone who'll treat me as an intelligent partner in mine or my children's health. I'm not naive enough to think that doctors know everything, so I really don't appreciate those who, in an attempt to come across as knowing it all, won't share what they do and don't know.

  2. Dr. Van De Graaff

    Jen, Your comments remind me of a haircut I once received. I made the mistake of straying from my usual barber and ending up in the chair of a young female hairstylist who couldn't seem to stop talking. She informed me that it is a well-known fact that salon patrons really don't care what kind of haircut they receive as long as their stylist has a fun and engaging personality. "In fact," she maintained, "as a stylist you don't really have to know much at all about cutting hair to be successful. You just have to have the right gift of gab." Needless to say I came away with one of the worst haircuts of my life. It sounds like you've got the right attitude about choosing your doctor. There's no point in seeking a medical opinion from someone who is clinically inadequate just because he or she has the right "gift of gab." I agree that clinical competence should be at the top of the list. The unfortunate fact remains that competence is common (thankfully) in my profession, but good bedside manner is in rarer supply. You don't really have to go far to find a doctor that dispenses the right diagnosis and treatment (most patients don't have illnesses that perplex all but the "Houses" of the profession). But sometimes it's a bit of a challenge to find one who communicates well with you. Thanks for the comments. Dr. Van De Graaff

  3. Jen

    Interesting post! I've actually had a discussion kind of like this with my husband recently and I must admit that I have a slightly different take. Sure, in a perfect world all of our doctors would have amazing interpersonal skills AND expansive clinical expertise - but, as a patient, if I had to choose one over the other, I would ABSOLUTELY choose clinical competence. (For the sake of embarrassing full disclosure - this came up during a discussion about the tv show House, during which I said that I would prefer to see a doctor like him than a super-friendly one who can't diagnose what's wrong with me. Sounds kind of like the cardiologist from Ohio you referred to). In a nutshell, I'm not going to my doctor's office to find a friend. If I come away with one - awesome. But what I'm really after is an expert who can make/keep me healthy.

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