USA Today: Doctors often shift focus from patients to themselves

Posted by Kendall Harmon

Internist Howard Beckman used to try to inspire older patients by talking about his active mother, who, in her late 80s, walked two miles a day. "It worked great until she wasn't doing so well," says Beckman, whose mother is now 94. By then, people got used to asking, 'How's your mother?' I'd have to say, 'Well, she's struggling.' "
Patients began worrying about his mother, and they wondered how good a doctor he was if he couldn't even keep his own mother healthy.

Beckman had thought that talking about himself and his family strengthened his connection with patients, but he came to realize it wasn't such a good thing. "It created a complex set of issues, totally unnecessary in caring for these people."

Beckman has more proof. He's a co-author of a study published today in the Archives of Internal Medicine titled "Physician Self-disclosure in Primary Care Visits," or "Enough About You, What About Me?"

Read it all.

Filed under: * Culture-WatchHealth & Medicine

Posted June 27, 2007 at 10:23 am [Printer Friendly] [Print w/ comments]

1. Mike Bertaut wrote:

This research points to another trend we have identified, especially with seniors.  We have several studies (I work at BCBSLA as an Intelligence Analyst) that had us scratching our heads, because they indicated that our insured that were LEAST satisfied with their physicians were having BETTER outcomes than the HIGHLY satisfied. 
What we think is going on, is that the friendliest doctors, the ones with good people skills/bedside manner are spending their limited time in an office visit, well…visiting..when they should be focused on the patient’s condition.  The more brusque, less friendly doctors who “get right down to it” are more likely to uncover hidden maladies and prescribe effective treatment sooner.
So the moral of the story is….if you are really friendly with your doctor, you’re probably not getting the best care.
Strange world…I know…

June 27, 11:17 am | [comment link]
2. NWOhio Anglican wrote:

Call it the “House” school of bedside manner.

June 27, 3:19 pm | [comment link]
3. robroy wrote:

I try to be a kind and compassionate physician. Maybe I should be more “House”-like. There is an interesting phenomenon. The rude and callous physicians are often seen to more skilled than they actually are. “If they are that mean, they must be really good.” The truth is usually the opposite.

My main mentor in residency was a kind, compassionate, Godly and very skilled surgeon but quiet and unassuming who would never sing his own praises. After he stepped out, and it was just the patients and us residents, they would routinely question us whether he was competent.

June 27, 5:24 pm | [comment link]
4. Mike Bertaut wrote:

Robroy #3:  I am comfortable from where I sit that you are on the right track.  The real issue here for me, is that our reimbursement incentives are all in the wrong places.  We tend to pay more money to physicians for the wrong reasons when compared to long term outcomes. 
It’s like the man who lost his wallet in the alley, when a friend noticed he was looking for it under a streetlamp 50 yards away, he responded “Well, the light is better here!”  We tend to track based on what’s easy as opposed to what’s relevant. 
If I was the King (heaven forbid), I’d double FP, GP, and Endocrinologist reimursement rates, require a 20 minute office visit, and make up the savings by imposing real quality standards on the highest paid of the specialists (of which there are typically 30-40% more than the system actually needs).  I’m comfortable in the long run this would have the most positive impact on healthcare.
But then again, I ain’t the King.

June 27, 6:39 pm | [comment link]
5. robroy wrote:

Dear Mike, as a specialist (otolaryngology), I am highly offended with your comment! No, not really, but I am privileged to not have the time crunch the primary docs are facing. It is interesting that you include endocrinologists (very much specialists) and not pediatricians and internists.

Another remark: Currently, there is making its way through the system, something call pay for performance or PFP or P4P. I am totally against it. How can one be against paying for quality? What it entails that one will pay PCPs more if a greater percentage of the the patients have pap smears, mammograms, PSA tests, etc. Sounds great, right? Well if you go in once a year for sinusitis and you get an 8 minute slot. Seven minutes will be spent on preventive medicine. “What were you here for? Oh, you’ll have to come back for that.” Plus, the primary care docs will have to hire full time actuaries to crank out these numbers. Plus, it won’t be pay more for performance but pay less for arbitrary and extremely cumbersome statistics. Plus, it will hit PCPs disproportionately hard. The is already a dearth of primary docs. Add these regulations, and there will truly be a crisis.

June 27, 8:38 pm | [comment link]
6. Mike Bertaut wrote:

To Robroy:
Yeah, we’re looking at about a zillion different P4P standards right now, trying to see if the marketplace will embrace any of them.  Not that I think they are terrible, I just think they are putting the emphasis in the wrong place.  Quality is a heck of a lot easier to measure at the facility (hospital) level for us, where we continue to see HUGE disparities in acceptable charges (+ or - 300% in our little state) but our insured have no idea what they are getting for the money.
Oh, and there is a method to my madness in including endocrinologists:  Probably the biggest driver of our cost increases nowadays are uncontrolled diabetics, hyperlipidemia cases, hypertensives, and other typically obesity-related expenses.  Endo’s are currently THE most cost-effective way for us to intervene in these cases, because their reimbursement rates, well, if you were on them you’d probably be really aggravated.  We’ve found Endo’s intervene in an effective way to keep these folks out of the hospital which saves tons of money.  If I can save 2 days in the hospital (at our local charges) I can keep a patient on a statin, fortamet or equivalent, and blood pressure medicine for a year and have money left over.  Not to mention the risk avoidance in keeping them out of the most dangerous place in America (the hospital).
Sorry, I’ll bet you and I could jaw on this for a long time.  Yet another connection forced upon us by our apostate HOB!
See, God uses all for His purposes, one way or another.

June 27, 9:41 pm | [comment link]
7. drjoan wrote:

We studied student nurses and their “caring behaviors”—those behaviors which showed compassion and caring but not necessarily competency.  What we observed was that (1) nursing instructors WANTED caring but did not REWARD such behaviors—instead, we rewarded competency such as how to take a temperature or dress a wound or such—and (2) as students realized this, they actually dropped the caring behaviors in favor of competency.  In other words, they sort of adopted the House attitude over and the Marcus Welby one. 
We really wanted the caring behaviors to be enhanced so had to work to encourage them.  Students struggled with demonstrating compassion over and above competency.  So did we educators. 
I think the practitioners (doctors, nurses) WANT to “care” but are not rewarded in their practice by such behaviors.  The comments above bear this out. 
There has to be a Christian “compromise” for this need!

June 28, 1:00 am | [comment link]
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