66 Becoming a Patient
This preference for more bedside manner over more technical exper-
tise matched that of many patients. Indeed, slight gradations of technical
expertise, as well as broader distinctions in reputation, were difficult to
assess. Bradley, an elderly but athletic internist who first felt symptoms of
an MI while playing tennis, and afterward became depressed for the first
time, said:
The major input to people’s sense of the hospital experience was
the personal contact, not the size of their incision or the fact
that they had no postoperative infections. Consumers aren’t that
good at evaluating the quality of medical care anyway—even re-
ferring physicians aren’t that good. What does it mean when
the newspaper lists ‘‘the best doctors’’? They run a hundred-yard
dash faster to the operating room? How do you know?
Confrontation with illness and mortality provoked rare professional
candidness on assessments of the quality of colleagues. Bradley added,
Two or three guys were significantly above the rest of us in terms of
their ability to make patients well. But that’s rare. Most of us
have good days and bad days. Sometimes we miss something, or
astound the world by picking up something subtle. But basically,
the level of performance is pretty standard. There’s no correlation
between my role in making people better and the feedback I get
from them. The feedback is proportionate to how much time
I spend with the patient. The average patient would choose a
sympathetic, soft, and gentle hospital experience that had a slightly
greater risk of poor outcome, over a sterile, stark, unfriendly ex-
perience that had a slightly higher chance of a successful outcome.
Bradley felt that physicians’ attention to personal and psychological is-
sues was not only preferred, but medically important.
These doctors came to realize—often painfully—that reputation alone
was insufficient in choosing a doctor. Sally, the internist with cancer who
brought her laptop to the ICU, chose an internationally renowned expert
for whom an important procedure was named. But his poor bedside man-
ner appalled her, illustrating the gap between skills as a researcher (that
may build a reputation) and those of a clinician.
A colleague recommended his mentor, who was very smart but
quite dishonest, and not at all encouraging of anybody else’s
opinion. He wrote a note in my chart when he didn’t even see me!