COLUMBUS, Ohio, March 8 - Television doctor Gregory House is winning high ratings by being a rude, arrogant troublemaker, but he'd lose out big-time on a new scale that rates an ideal doctor.
The best physician is confident, empathetic, humane, personal, forthright, respectful, and thorough, according to a study in the March issue of Mayo Clinic Proceedings.
House - played by actor Hugh Laurie as a limping curmudgeon who despises patients but loves their diseases - fails miserably to meet most of the standards, according to research conducted by Neeli Bendapudi, Ph.D., of Ohio State and colleagues.
House is presented as a brilliant diagnostician, but his technical competence wouldn't enter the equation, Dr. Bendapudi and colleagues concluded, because most patients can't judge medical skill even after they have been treated.
Instead, patients judge doctors on the basis of how they behave in the clinic and office, the researchers concluded.
"Patients can sense if the physician is rushed, preoccupied, tired, aloof, disinterested, or alarmed just as they can sense a physician's genuine interest, compassion, calmness, and confidence," the researchers said.
The study is based on interviews with a random sample of 192 patients who were seen in 14 different medical specialties at the Mayo Clinic in Scottsdale, Ariz., and the Mayo Clinic in Rochester, Minn.
The interviews, focused on the patient-physician interaction, lasted between 20 and 50 minutes. Patients described their best and worst experiences with a doctor in the Mayo Clinic system and gave specifics of the encounter.
From those interviews, Dr. Bendapudi and colleagues extracted the seven key attributes that would make up the ideal doctor.
Of the seven, the most mentioned was "thorough," the researchers noted, while "empathetic" came up least frequently.
The study is one of the first of its kind and therefore valuable, said James Li, M.D., Ph.D., of the Mayor Clinic in Rochester, but it has several key limitations, including a lack of information about the demographic characteristics of the interviewees.
Several studies have shown that minorities and women were more likely to feel they got less-than-ideal treatment, Dr. Li wrote in an accompanying editorial. "It would be informative to know more detail about the interviewed patients," he said.
Other limitations, acknowledged by the researchers, are that the data are qualitative and that the subjects were all involved with one institution, which may limit the generalizabilty of the work.
However, they added, the study is exploratory and was not intended to say anything about the "prevalence of phenomena." Also, they noted, patients in the study had wide experience in the health-care system.
"Our respondents drew from a rich experience base when commenting on Mayo Clinic physicians," they said.
Dr. Li added that health care can't be high-quality if physicians are seen as hurried, disrespectful, cold, or callous.
Dr. Li said it's up to the medical community to find ways design a health care system that encourages doctors to exhibit positive qualities during the clinical encounter.
"A physician who pays personal attention to the patient -- who is respectful, compassionate and competent -- that's what every patient wants," Dr. Li wrote.
The authors introduced the concept of clue management which they feel "may be a useful tool for transforming the broader behavioral themes into discrete behaviors that positively affect patient perceptions of the service experience." As an example, for the ideal physician behavior of "thorough," the illustrative "humanic" clues would be:
* Provides detailed explanations.
* Gives instructions in writing.
* Follows up in a timely manner,
* Expresses to patient desire to consult other clinicians or research literature on a difficult case.
As another example, the illustrative "humanic" clues for "confident" would be:
* Refers to state-of-the-art medical practices.
* Refers to experience in treating specific medical conditions or performing procedures.
* Is not disturbed by patient's queries about medical information acquired from other sources (regardless of accuracy or inaccuracy).
* Is at ease in the presence of patient, family members, and medical colleagues.
http://www.medpagetoday.com/PublicHe...gement/tb/2816
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