June 26, 2007

Do doctors waste your time by talking about themselves?

They're just trying to be friendly. They've heard they're supposed to have rapport or something.
The researchers studied the conversations looking for any hint that patients were helped when the doctors talked about themselves.

“We looked for any statement of comfort, any statement of appreciation, any deepening of the conversation,” Dr. Beckman said.

They found none.
None!

What is going on here? Is it something about the sort of person who becomes a doctor?

32 comments:

George said...

Happened to me just last week. I told the doctor my parents were ailing. So he starts telling me about his parents!!

He also cracked three jokes totally deadpan. Each time I had to look him in the eyes to be sure he was kidding. Jokes like..."Now that you've been a victim or the medical system, you know, I mean customer, patient of the medical system..."

Plus, his nurses have tattoos. And the intake form I filled out had three typos.

Of course, I am in prison in Joliet, Illinois, so maybe I should just be grateful for what I can get.

Troy said...

Wouldn't it be tad freaky if your doctor is reassuring you and nothing is wrong? Besides sports or wine or the weather what else would he or she talk about that might not affect blood pressure or rapport? Politics? Religion? Healthcare costs?

Most doctors that I've exprienced talk about themselves, but only because I'm talking about myself. "Hurts here", etc. And they usually ask -- "What do you do?" kids, etc.

Bootom line for me: Get in, get out.

Meade said...

Shy self-effacing people seldom make it through med school.

vet66 said...

My Doctors, a Primary Care Physician (PCP) and a dermatologist are fine gentlemen who are not narcissists but interested in establishing a rapport. They must adapt to each patient's level of dialogue and diagnose symptoms in about 15 minutes. It is difficult.

There is also very little time for hooray for me doctors who try to lead by example. Most Doctors enjoy helping people. They also enjoy people who want to help themselves. I always start the conversation by saying "Hi Doc, how's it going?" If he is late, so what. It is good to be nice to someone who is about to check your prostate or take a PAP smear, as the case may be. A happy Doc makes fewer mistakes.

If your Doctor lacks humility, find another Doctor.

Mindsteps said...

I reviewed the abstract of the article reported on in the times.

Unfortunately, I do not have access (unpaid) to the full study. I would be interested in learning if there were any gender differences amongst the physicians or if this was even a variable examined, or controlled for, in the study.

Baron-Cohen, an autism researcher out of England has developed a controversial theory of autism that he termed 'the extreme male brain theory' of autistic spectrum disorders. He claims that at a population level, males are better systematizers and females are better empathizers. At the extreme, one might find individuals in the autistic spectrum, who are much better at storing, retrieving, and systematizing details and tend to have significant difficulty competently expressing and comprehending both verbal and non-verbal in interpersonal encounters and seeing the 'big picture'. He has also published studies that seem to indicate that these gender differences may show up morphologically in the structure of the brain.

In the mental health side of things, there is some data that suggests that, in general, clients report feeling more understood by female therapists than by male therapists.

Again, these are generalizations....I know women who are incredible systematizers and men who are wonderfully empathic.

bill said...

Most people overestimate their ability to hold a conversation or to even sound the least bit interesting. I'd like to sponsor a national STFU week.

If you have something important to say or an exchange of information is necessary, that's okay. But no chit chat, no pleasantries, just STFU and keep your banal thoughts to yourself.

Theo Boehm said...

Well, it depends on what the doctor has to say, doesn't it?

I was in an eye clinic waiting rooom the other day, and the director came out and was chatting up some patients.  He was obviously trying to establish rapport, etc., but nobody was having any of it.  One young woman finally said she was in too much pain to talk, and had to be taken to another room.  Another couple of guys just stared into space.  It was embarrassing.

On the other hand, I'm always glad to talk to my ophthalmologist.  I've been seeing her for probably 15 years, and she's one of the most delightful people I've ever met.  We compare notes on our kids, family life, etc.  She's told me stories about eye problems of artists and historical figures that, despite being a font of trivia, I frankly had no idea about.  She's funny and always great to chat with on any subject, but we always cover what we need to medically.  And I'm not the only one who appreciates her company.  From everyone I've talked to about her, including other patients, physicians, and nurses, I can honestly say she is a beloved figure.

My primary care doctor is a charming guy, as well.  He's a Professor of Medicine at Harvard, and he did his undergraduate work at Harvard, as well.  He's one of the most broadly educated, amusing, and frankly civilized people I've met.  He never makes you feel rushed.  It always seems like there's time to chat about things, but somehow everything is to the point and not dragged out.  Topics we're touched on in recent years:

    1.   The operas of Wagner, including Wagner's aesthetic theories, the best singers we've heard, etc.
    2.   The state of the BSO, including what direction James Levine will take the orchestra, and what Seiji Ozawa's legacy will be, and whether he was a really great Mahler conductor, etc.
    3.   The best restaurants and where to stay in Old Town, Alexandria, Virginia.
    4.   A couple of interesting restaurants we shouldn't miss next time we're in New York, and some of the new plays we might see, etc.
    5.   Catholic Church politics, including the fine work of the pastor and musical director at one of the important churches in Boston, and the difficulties finding replacements now that they're retiring.

That's just a sample. We always manage to cover everything medically, but I feel like I've just had an exhilarating chat with a guest at a dinner party in Cambridge who is a senior faculty member at Harvard.  Aside from the dinner party part, that's actually the case, and I always look forward to seeing him again.

Moral of the story (other than ol' Theo being a lucky boy): If you don't have the charisma, education, and charm of these two, just shut up.

Bruce Hayden said...

I might suggest that part of the problem, if there is one, is that MDs are to some extent, the ultimate dorks - at least the mid to older ones. What do you expect when they likely need a science major and almost straight As in college to get into Med school?

I think that the most accurate doctor show on the air right now is "Scrubs", which makes fun of the fact that most doctors are social losers without a clue. Of course, the attorney on the show looks a lot worse, which is hard.

Things may be getting a little better with doctors, with the economics of the field making it a little less desirable a profession. I know of one younger doc who was a wine steward at at resort until his position got streamlined in a corporate overhaul, at which time, he went to medical school.

Internet Ronin said...

As someone with a chronic health problem who, as a result, has had to see a variety of practitioners on a frequent basis for over 20 years, I have never encountered any situation remotely resembling the issues highlighted in the article.

Kirby Olson said...

I've felt almost like a therapist on some occasions. I heard all about a doctor's divorce, and the subsequent mayhem, and when I left I realized that I hadn't even brought up my child's medical problem for which we went except as almost a side issue.

Her answer, come back in a year or so, and see if it still needs attention. Meanwhile, she said that she was going to retire and gave us a long story of all the fun things she was going to do.

jimbino said...

The animals at the Vet have it worse, since they can't talk back. That's the worst thing about going to the dentist too, that you can't talk back.

I don't care how much a doc talks about himself as long as he gives me a discount for cash payment in lieu of credit card and a discount for not having to deal with my insurance claim.

The Hippocratic Oath is a joke. I should include a prohibition on wallet biopsies and a provision to treat all patients fairly when it comes to bills.

TMink said...

Mindsteps, I think that the theory you wrote of is really quite interesting. It does not strike me as anti-male at all.

In a similar vein, the fight or flight research was done with males. Most old research was, and the (mostly male) researchers considered female subject's menstral cycle a confounding variable that they wanted to exclude from their research. Sound like statistically propped up bias to me, but anyway.

Subsequent researchers noticed the exclusion and did the same research with female subjects and found a new response: Tend or befriend.

http://www.apa.org/monitor/julaug00/stress.html

Rather than fight or run, this strategy builds relationship by helping or affiliating with the person causing the stress. It can be seen in female lions who "welcome" a new male into the pride. Perhaps by doing so he will not kill all the cubs, I do not know.

So in terms of male/female brain differences, it is important to remember that we are talking about differences on average, but also important to acknowledge real differences. Looking at autism as hypermale thought patterns is not unreasonable or male bashing in my opinion.

Trey

Synova said...

My surgeon had no clue socially. I found it rather reassuring. I figured she must be using all her brain power for important things.

I still rather wish she hadn't told me (this is how clueless she was) that a nurse at the hospital had looked at my chart and said "I'd be too embarrassed about that." (with a few more details) and my surgeon said, "No you wouldn't, you'd be in pain."

And she *told* me. ARRGH!

Nels said...

I find it calms my nerves when the dentist speaks to me, even if about herself. There's something dehumanizing about lying there as sharp objects are stuck into my open mouth, and it's reassuring to be recognized as a person by the dentist.

Mindsteps said...

Tmink wrote:

TMink said...
Mindsteps, I think that the theory you wrote of is really quite interesting. It does not strike me as anti-male at all.

I did not indicate it, but the theory is somewhat controversial from a scientifc perspective, as opposed to a social, cultural, or ideological perspective.

I find it interesting as well, and there is nascent scientific support for it, as well as anecdotal support, from a few differing sources. However, other researchers suggest that there is probably more then one pathway to autism, and some scientists have asserted that women with high functioning autism may be more difficult to diagnose than males. However, the study of autism, especially from a neurobiological level, has opened up some very compelling lines of research into the biological bases of interpersonal communication. For example, within the past ten years, scientists have identified the existence of 'mirror' neurons in monkeys and humans that may be the seat of imitation, modeling, and empathy. If I raise my arm, for instance, your mirror neurons are likely to fire in the motor areas of your brain, analagous to my neurons, even when you do not move your arm. Researchers in Canada, Italy, and L.A. have found that autistic individuals exhibit impairments in the activity of mirror neurons when compared to non-autistic individuals with comparable IQ's. It is astounding stuff!

I am a male, but I am a lousy systematizer, and others have pointed out that I am empathically impaired as well!

Peter Palladas said...

I'll generally take my doctoring as I do my barbering - in complete silence. Other, of course, than the necessary exchange of information required for a sound diagnosis and effective treatment.

Nonetheless when my latest consultant and I spent some twenty precious minutes of the NHS's time, whilst patients were expiring at his door, discussing the respective merits of live versus on-line poker I did come out feeling a whole lot better.

Not quite on a par with the time my surgeon and I discovered a mutual fondness for the music of The Grateful Dead. I do like a man who can be trusted to hum Truckin' whilst slicing the flesh.

"The man who saved my life is a Deadhead" reads the tee-shirt.

LoafingOaf said...

I know of one younger doc who was a wine steward at at resort until his position got streamlined in a corporate overhaul, at which time, he went to medical school.

My doctor worked with dolphins as a marine biologist before becoming a doctor to make more dough for his family. So I always get him chit chatting about dolphins when I'm being examined, and dolphins rock, so he rocks, making going to my physicals kinda fun.

LoafingOaf said...

I'll generally take my doctoring as I do my barbering - in complete silence.

I'd like to find a barber who didn't talk so much. I've let my hair grow too long just because I'm not in the mood for all the barber shop small talk. My current barber is always talking about football, Vegas and gambling, and I find myself looking up the latest on the Browns and Buckeyes before a haircut just so he won't feel bad that I don't care about football. But at least he has a drawer full of Playboys I can browse. lol

wpatterson3 said...

This was a very informative
article.
My doctor talks to himself during
the entire exam about what he is
doing and/or finding. It gets
interesting at times. You know, as
one who is a liberal, I am starting
to appreciate your unique
perspective. I sincerely apologize
for any nasty comments I may have
made in the past. You are now on
my must not miss list. I also have
a great appreciation for Dr.
Strangelove.

Pogo said...

I have done this on rare occasions with patients, usually when discussing what to do in times of near-panic (death, dying, or diability in a loved one). I do so to let them know I am giving advice I myself have taken, and I know what obstacles there might be. But it's brief; one sentence or so.

Otherwise, I ask and ask and ask. Tain't enough time for me to jabber any, when their own stories are so complex, and the point of the visit.

But it was not always like this. I know MDs of the old school who became close friends with their patients. Now those conversations are "time-wasters". No chit-chat. No rapport-building by trading stories. Just address the main question(s).

It's odd. People complain about being treated as objects, but then complain when you do something human like waste time with them. Oh well.

Message to young people: Don't go into medicine.

Theo Boehm said...

Pogo,

As you could tell from my story, I'm fortunate two have two doctors of the "old school."  They've taken the time to build rapport, and it's paid off:  I followed my ophthalmologist around Boston to keep her as my doc.  And I'm not the only one.  I also occasionally see my primary care guy in social settings, and he's always very friendly and engaging.  I like to think of him as almost a friend and someone I could talk with about a lot more than medicine.

The thing people miss is that this approach creates an atmosphere that's conducive to healing.  It's scary enough to have your eyeball invaded, much less by some asshole you hardly know, but developed a instant dislike for in the 15 minutes you've spent with him before the surgery.  It's a whole lot less stressful having the work done by someone you know and trust.  I literally get a warm, glowy feeling from the doctors I see the most, and I'm certain that has had beneficial effects on outcomes of specific problems, not to mention my health in general.

Your last sentence is terribly sad and frankly frightening to those of us who will be seeing doctors younger than ourselves for the rest of our lives.  Gizmos and better chemistry are not the answer to everything, in or out of medicine.

hdhouse said...

I did a stint while in grad school in a university hospital in a clinic as a screener and got to know the docs pretty well. Those attempts at chitchat are for a reason....

One doctor, a very very good ophthalmologist used to have the residents go sit in the waiting room (big clinic, lots of people, particularly indigent) in their street clothes and watch and listen to the patients talk. The "game" was to come up with the diagnosis before you examined them.

Its the old adage, the patient will give you the diagnosis if you talk with him about baseball.

Pogo said...

hdhouse,
Cool story. I believe that must have been pretty effective.

Theo,
It is a downer, sorry to say. I steered my own three kids away from medicine. I have talked other kids out of it as well. Why?

(1) They aren't rich, and they'll never be able to pay off the average $140K in loans as doctor pay declines.
(2) They're usually bright Sherlock Holmes types, always wondering why.... That part of medicine is being replaced by top-down cookbooks and lots of CYA actions that defeat one's moral sensibilities.
(3) It isn't any fun. It used to be fun. So what? I'm not paying you to have fun? Well, smart young people don't need to take jobs like this. Hell, get PA or NP training and make almost as much in less than half the time!

Theo, the dirty little secret is that the young people going into medicine now aren't as dedicated. They're clock-punchers, ready to transfer you to the next shift as soon as 5:01 p.m. hits. And I used to routinely run into "scary-smart" new docs when I started. Now I wonder how they got out of college biology with anything over a C.

Wa there a "good old days" in medicine? Yes. This ain't it.

jane said...

Too bad about the profession these days. And what lies ahead in terms of government managed care isn't a bright prospect, either.

But there has always been the Catch 22 complaint that doctors keep us waiting for scheduled appointments... and that he/she doesn’t spend enough time with each patient. The solution is for doctors to schedule us further apart, but most of us aren't willing to pay the extra money to offset the difference in income to pay medical office and personnel expenses and obscene liability insurance, or to understand why we can’t get that appointment when we need it.

We complain that doctors have a God complex while expecting divine healing miracles from them.

We say docs are in the pockets of the pharma industry, but demand the latest and best treatments on the market.

We complain about doctors doing too much testing to cover themselves, but are the first to take them to court for perceived misdiagnoses.

We complain that our physicians are too clinical and aloof and need to improve their bedside manner, but are now upset when they talk about themselves during our appointments- some of them gabbers, but probably the majority of them trying to humanize themselves and to disarm their patients in stressful situations.

Doctors are people, too. I don’t get regular check-ups b/c I don’t want to know if there’s anything wrong (will probably go to the third ring of hell for that), but last year I took my 5’10 teen who had gotten too skinny to an Indian doctor in our area . He was even more alarmed than I and said to us that she should weigh 160 to 170 pounds. I don’t think he meant to, but he sure lightened the situation by making us laugh. Whether he spoke from his cultural experience, personal preferences, or from Amazon height and weight charts, we couldn’t know, but we went home and ate. Daughter gained back her needed 15 pounds by moving to an apartment with a working kitchen and so a happy ending.

I’m thankful for all of the testing Dr. R did to eliminate the possibility of disease and put a mother’s mind at ease. And we enjoyed the fact he talked a bit about India.

jane said...

"Do doctors *waste* your time by talking about themselves?"

Years ago I stayed the summer with a doctor friend and his wife who needed help with the restoration of their fun and frilly pink Queen Anne. Dr. Rick was a small town GP whose patients liked to talk a lot. Said he couldn’t help the ones who launched into personal probs, other than to recommend a more appropriate professional. The patients who gave him a litany of physical complaints often just needed a laying on of hands to feel better, and so he obliged.

But he had a surprising percentage of patients who would describe their bathroom “doings” in vivid detail, some even calling him at home to tell him the latest news of what their toilet bowl looked like. The most annoying aspect of the situation for Rick was that he had to listen, in case there were ever a genuine problem. Finally in exasperation, Rick started to reciprocate and share with these patients wicked descriptions of his own “business.” Said the problem of anal-retentive fecal matters flushed right down the drain.

Pogo said...

Dare I?

Once, a patient came in with a paper bag. She didn't discuss it until, at the end of her litany of the bowels she said to me, "Here, I brought them in just to show you".

She had frozen her 'samples' on paper plates, & covered them with Saran wrap. She had signed and dated (yes, signed) each one.

I can only imagine her waiting room conversations.

jane said...

LOL- Bet you turned down that dinner party invite to her house.

Aren't tea leaves easier to read, anyway?

Theo Boehm said...

Its the old adage, the patient will give you the diagnosis if you talk with him about baseball.

Yes, my doctor said as much in almost so many words.  After chatting a few minutes, he would often ask an insightful question or two.  I asked him how he did that, and he said he could tell a lot about patients just by talking with them.  After that, I could see the wheels turning when we were shooting the breeze.

That said, I once asked why he still saw so many patients when he was in a position to ascend into one or another medical heaven, free of such a daily grind.  His response was that he enjoyed meeting so many interesting people and thrived on the interaction.  I suppose that's one part of Pogo's "fun" that's going away with our new corporate farm cattle herd veterinary model of medical care (You know the mantra, "Better, Faster, Cheaper.")

In addition to the topics I mentioned in my first comment, we could discuss Catholic theology, Spinoza, and, if Christian thinking was a little too narrow for you, he could quote the Vedas...in Sanskrit.

Talk about scary smart—but in his case it has been charming smart.  From what Pogo says, I don't think we'll see too many of his kind again.

Pogo said...

1. That is precisley the fun in medicine, now gone for the most part. The 'mystery' aspect is another, but now one can only play a hunch by lying about the test you want. Hunches aren't allowed. Now it's protocols, algorithms, and Evidence-Based medicine. Even then, you will likely be denied the test.

2. My favorite scary smart doc was one whose sole oral board question (in those days you stood before a panel who quizzed you) was a European map from the 1600s, dotted with colored pins.

He was the only candidate who could answer the question "Describe this disease."

The pins were all at ports (not actually obvious to those lacking knowledge of European geography). He correctly surmised that sailors were carrying some disease around with them. Scurvy? No, syphilis. He died at 68, still working. Happy sonofabitch.

Nowadays when you read doctor-type magazines, all of the articles are about early retirement. Paul Johnson calls such exit tactics the politics of despair.

Mr.Murder said...

What's up doc?(/munching on carrot, sans onion rings)

Mr. B. said...

Atul Gawande

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