What makes a good doctor?

What makes a good doctor? Beneath that simple question is a surprisingly complex answer.

All physicians have a combination of bedside manner that will work better with some patients than others, and technical skill that will be more applicable to some patients than others. There’s also not a false dichotomy of having to choose a physician with a great bedside manner rather than one who has amazing technical skills. Both of those attributes will be on a spectrum and one may matter more to you at one point in your life than another. But when you choose a doctor, you should at least have an understanding of what’s most important to you in that setting.

When is bedside manner most important?

In cases in which the problem or solution is not clear.

If the problem isn’t clear, you need someone who will listen to your story and ask thoughtful questions. They may pick up on a detail someone else missed, or ask you a question that reminds you of a detail.

Many medical issues with elusive diagnoses take a long time and many steps to arrive at a diagnosis, and for many people a diagnosis may never arrive, or will arrive only after a new symptom presents itself. In these cases you need someone who will be your partner, someone you trust to listen to your experience and find a way forward together.

Bedside manner is similarly important in primary care physicians. They are often the ones making the “first diagnosis”, then referring a patient on to more specialized care. If they don’t listen to you, it’s much less likely they’ll hear the symptoms that will lead them down the right path. A large part of primary care is health maintenance, and having a physician you trust has been shown to improve health outcomes.

When is technical skill most important?

When the problem and solution are clear.

Let me be clear that I am referring to technical skill as not just surgical or procedural skills, but also specialized medical knowledge.

You have a brain aneurysm, for example. You want to go to the physician who does ten brain aneurysm surgeries a week. No matter how much your surgeon listens to you, your outcome will depend mostly on how well s/he deals with the aneurysm surgically.

Would it be nice if the surgeon also had an amazing bedside manner? Of course, and many do.

And there are some situations in which a technical skill plus bedside manner will absolutely provide the best outcome. But no one is perfect, and everyone has strengths and weaknesses.

The best predictor of a physician’s technical skill is how many times s/he deals with that particular problem.

If you have a problem that is relatively uncommon, you want to see someone who has dealt with that problem many, many times. The surgical literature is clear that surgeons with the best outcomes are those who do that procedure most frequently.

Similarly, an endocrinologist who specializes in difficult to control diabetes, for example, is going to have more ideas about how to handle your situation than one who specializes in growth disorders.

In summary, if you have a specific problem, you want to prioritize finding someone who deals with that problem all the time over someone who has an amazing bedside manner.

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