Who(m) Do You Trust?
When I wrote The Trusted Advisor with David Maister and Rob Galford, we each contributed examples. One of Galford’s surprised me. As we told it in the book:
One of Rob’s children was diagnosed as having a serious medical condition when she was barely three years old. Given the complexity and potential severity of the situation, she was referred to a highly specialized surgeon at Children’s Hospital in Boston who was sufficiently famous to have been the subject of a book, written about him and his work, complete with photographs of his hands. From the standpoint of credibility and reliability, few people in the world could match him. But his intimacy skills were not among the highest, to be sure.
This was pointedly obvious when, at the end of six hours of surgery on Rob’s daughter, the surgeon emerged from the operating room saying to the anxious parents, “Don’t worry. He’s fine.” Rob and his wife, Susan, almost shouted in unison, “She’s a she!” He shrugged and casually said, “Oh, yeah, I meant to say ‘she.’ Anyway, she’ll be fine. Complex surgery. Interesting case. We videotaped it.” With that, he strolled away, leaving two grateful yet dumbfounded parents in his wake.
As I recall, Rob and Susan had chosen this physician knowing full well his deficit of bedside manner. Rob offered this example initially (again, as I recall) as an example of how when it comes to life-threatening situations, we default to technical excellence and credibility.
I recall thinking that, if anything, such life and death situations make us more willing to trust those who seem to care about us and listen to us than to those who lead with brute competence.
It sparked a good discussion between the three of us, and the language we ended up with in the book said
“Did this surgeon “get away with it?” Yes. Can you get by only on technical excellence? Yes, you can, barely, if you’re world-famous. The rest of us cannot.
Fast forward. My sister has been fighting a virulent form of cancer for a decade or so. When it came back recently after a long remission, she went to her prior clinic. The clinic has a renowned oncologist on staff.
The physician recommended an aggressive program of treatment. My sister is an RN, with a record that includes work in midwifery and hospice; she’s seen them coming and going, as she says. And so she asked some questions about the possibility of delaying treatment a few weeks to spend a Thanksgiving with relatives and her new husband and family.
“Are you serious about surviving or not?” was his basic response. “I’m telling what you’ve got to do; you asked my advice, I told you. You need to start treatment now—tomorrow, not two weeks from now. Don’t waste my time if you’re not serious, other people need me.”
She sought out another doctor, also well-respected. He gave her a completely different line of treatment. He also talked to her like an equal—on his own time, over lunch, with respect for her decision.
She went with him. 3 months later, she’s out of the wheelchair and seems nearly symptom free again.
The point is not who was right and who wrong; she’d be the first to say there are no guarantees with cancer.
The question is: when it comes down to something like that—life and death—who do you trust? Do you go with the credentialized expert? Or the one who cares?
I suspect Rob would make the same decision again. I suspect my sister would make hers again as well.
How about you? Who(m) would you trust?
Bravo to bedside manner. It is undoubtedly a very difficult decision to make, but since many studies suggest a link between the patient’s state of mind and their ability to recover quickly and fully, I’d always go with the doctor who exudes and instills confidence and positivity.
Brusque, bullying doctors leave bad feelings and nagging doubts.
The very best wishes to your sister.
Regards,
Kelly
Charlie: In my situation where similar decisions had to be made, I went w/ my "gut". My "gut" meant that I needed a comfort level w/ the doctor (SME), regardless of their reputation . To be fair, I was choosing between "A" level compared to "A " level and not between "C" and "A". I made my decisions on how comfortable I would be after the fact, regarddless of the outcome. Would I be second guessing myself? I didn’t want the "woulda, coulda, shoulda" thoughts & anxiety. I opted for the "docs" that appeared to "care" ( they were willing to look at me, talk it through w/ me without looking at a watch, and then listen ). I’ve always believed that I’d want only the best for my loved ones; the best turned out to be the one who thought of me or the loved one as a person – not just a "case". I went w/ more than a text book. But then, that’s me!
I don’t know how I would answer. But, this blog consistently provides thought-provoking articles just like this one and it makes me think.
Thanks, Charles, for writing it.
Kelly, thanks for the kind wishes. Barbara, that may be you but it’s probably me too. And Scot, thanks for the compliment.
I’m late chiming in here, but have to agree with the bedside manner option as my first choice … and loudly echo Kelly’s assertion that there is a link between caring/compassion and healing. I say a heartless SME is a toxic SME — especially in the cases described in this blog post.
Thanks for sharing your very personal experience with this, Charlie …
I know how I did decide when it came to having vascular surgery last year — I went for the technical excellence but, and this is a VERY BIG BUT, this wonderful surgeon (who can be bitingly sarcastic) has a marvellous people-oriented back-up team who laud his skill in the operating theatre. It’s a good mix — and it works.
Taking this into a real-life business world I suspect that most of us will do business with people that they like rather than the technical person with no communication skills.
Charlie: To me the answer is clear. An attitude of compassion combined with competence will always produce better results. Technique divorced from compassion may result in a successful outcome. But not a better outcome. Why? Because even the most gifted surgeon is part of a larger enterprise. If the surgeon forces every one around her to act defensively or be resentful then then the universe of best outcomes has been shrunk. Creating an atmosphere of trust where new ideas and skills are not just tolerated but celebrated isn’t just a novel notion of the moment. It has always been the best way for people to deal with each other as they solve problems.
I think that bedside manner is very key in choosing a caregiver. A person with an abrasive manner will put me on the defensive and I would be less likely to follow their recommendations. Luckily for my family we managed to get both technical excellence and a caring bedside manner from the cardiologists and surgeons that have taken care of my son because of his heart defect. It makes it easier for me to let them treat him if I feel that they asking him to go through the things he has had to because it is very necessary.
I am a fan of House the show but would never let House the doctor treat me or my family. He runs tests and comes up with treatments willy nilly often bringing the patient to the brink of death. It makes for great TV but I would rather my doctor take careful consideration of the situation before coming up with a crazy treatment.
Compassion and skill aren’t mutally exclusive. In addition to all the good reasons listed above, there is another reason for good bedside manner. Human beings aren’t computers or cars. You can’t plug one into a diagnostic machine and get information. While some diagnoses are cut and dry, other require talking AND listening to what a person has to say.
Psychosocial issues can also be crucial to a person’s treatment and recovery. You can have the most skilled physician ever, but if the patient doesn’t take their follow up meds or can’t get physical therapy because they don’t have insurance, it won’t matter.
And, just to pick nits, why are the doctor’s always portrayed as the cranky but skilled providers and the nurses are warm and fuzzy?
Well said, TC.
As to your "nit" about doctors and nurses, I suppose it’s because the nurse is the one who actually gives what feels like the care.
More mischievously, I was going to suggest comparing the ANA (American Nursing Association) President
and the AMA (American Medical Association) President
but it turns out they both look pretty good.
Charlie, did you happen to see any of today’s coverage about the report by by the Dartmouth Atlas Project and the Foundation for Informed Medical Decisions on the influence of location on elective surgery rates?
It really drives home the importance of making sure your doctor is a trustworthy trusted advisor.