From Marcus Welby to Gregory House

Elyas Bakhtiari, for HealthLeaders Media, September 25, 2008

If physicians could be characterized solely based on television stereotypes, the difference between today's doctors and yesterday's would be stark. On the one hand is the revered Marcus Welby, whose patient-centered focus and pleasant demeanor still represents the ideal practice style for family and community doctors.

On the other is Gregory House, a brilliant diagnostician known as much for his horrible bedside manner and abruptness with patients as his cleverness at diagnosing rare diseases. One of the show's plot points even involves mandatory shifts at a walk-in clinic as punishment for his bad attitude.

Of course physicians can't all be pigeonholed based on television characters. But there may be some truth in fiction.

If there's one subject that's been on my radar screen more than any other in the last few months it's the troubled state of the doctor-patient relationship. I initially wrote about it last month after the New York Times declared the relationship "on the rocks." And it keeps popping up in story after story.

This week USA Today covered a study of VA physicians that found "cancer specialists and surgeons rarely responded with empathy to patients' concerns." Researchers studied audio recordings of doctor-patient interactions and found that physicians missed nearly every opportunity to show empathy in response to patient comments such as "this is overwhelming" or "I'm fighting it."

In a JAMA submission this month, researchers suggested that medical students may need education in emotional intelligence to become more sensitive to their patients. In the New York Times, Pauline Chen, MD, warns of the "tyranny of diagnosis" that can shift doctors" focus to the disease rather than the patient.

House's response to this type of alarm ringing: "What would you want, a doctor who holds your hand while you die, or a doctor who ignores you while you get better?"

He has a point. Physicians tackle extraordinarily complex problems every day—from patient diagnoses and medical codes to technology implementation and managed care contracts—that can make issues of emotional connection and proper sensitivity pale in comparison.

Even I have a similar aversion to what reporters refer to as "squishy" topics. After writing about emerging hospital-physician business strategies or following a major piece of Medicare legislation, a topic like doctor-patient communication can seem a little soft.

But House doesn't have to worry about payer rankings, losing patients to competitors, or performance-based compensation—all of which can be influenced by poor patient satisfaction. And his plans to cure a patient with his diagnostic skills alone may not be as effective as he thinks—patients are less likely to adhere to medication plans and treatment options when dissatisfied with their doctor.

As the physician shortage intensifies and workloads increase, doctors will have less time for patient interactions and communication will become a bigger challenge during a time when patients are more demanding than ever.

The solution, for the most part, is easy enough. You just have to make it a priority, for yourself and your organization.

That doesn't necessarily mean getting in touch with your sensitive side. Communication skills are in large part about knowing what to say and when to say it. I got the chance recently to edit communication scripts, forms, and checklists for a new book, Physician Entrepreneurs: The Quality Patient Experience, and most of them are straightforward but far too often overlooked engagement strategies—call the patient by name, give your full attention, etc. But they work.

The fact is, Marcus Welby is gone, and today's doctors don't have the time for his approach to patient care. But there's a lot more the Houses of the world can do to keep patients happy in today's hectic healthcare environment.

Elyas Bakhtiari is a managing editor with HealthLeaders Media. He can be reached at

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