I consider one of my credentials to be the fact that I am the daughter of a R.N. and M.D.. Such has provided me with an insight to the medicine practiced before insurance ruled the world. My Dad is, "Doc" ,in our small town; and I was a regular staff member at his office from birth. To observe his bed-side manner over the years, I noticed that he was caring, genuine, and honest, .even if it wasn't what they didn't want to hear. Extraneous procedures were not considered as there was no need to rip off the insurance provider. Furthermore, pharmaceutical companies had not taken their stronghold as of yet, either, so patients let their doctors tell them what was wrong with them, not T.V. advertisements. Perhaps this made medicine easier to provide, it is a two-way street.

I will spare you my high horse on the seven deadly sins: greed and gluttony, and remind you of "Doc". He took me on house calls with him when I was little. Remember those? Kindness, compassion, and consideration should be values every healthcare person honors. Healthcare has taken a nose dive with respect to the human service it should exemplify. Paranoia of the 'what-if ?!,' potential, leading to a downward spiral of lawsuit la-la-land, has destroyed our ability to trust our fellow humans. There I go again on my high horse, sorry, but I think you see my point. How can we regain our humanity, that we have lost while treating humans? I would like to think it is possible again, and better with advancements and the like....

Sorry if this doesn't help, but thanks for the indulgence of mind. Good luck!

Completely agree with Mr Tahir Khan.. medicines are secondary.. Attitude matters.. its more important how a clinician greets and listens to his patient, which can make all the difference.. Smile is the killer of anxiety of the patients, where the actual treatment begins..

I consider one of my credentials to be the fact that I am the daughter of a R.N. and M.D.. Such has provided me with an insight to the medicine practiced before insurance ruled the world. My Dad is, "Doc" ,in our small town; and I was a regular staff member at his office from birth. To observe his bed-side manner over the years, I noticed that he was caring, genuine, and honest, .even if it wasn't what they didn't want to hear. Extraneous procedures were not considered as there was no need to rip off the insurance provider. Furthermore, pharmaceutical companies had not taken their stronghold as of yet, either, so patients let their doctors tell them what was wrong with them, not T.V. advertisements. Perhaps this made medicine easier to provide, it is a two-way street.

I will spare you my high horse on the seven deadly sins: greed and gluttony, and remind you of "Doc". He took me on house calls with him when I was little. Remember those? Kindness, compassion, and consideration should be values every healthcare person honors. Healthcare has taken a nose dive with respect to the human service it should exemplify. Paranoia of the 'what-if ?!,' potential, leading to a downward spiral of lawsuit la-la-land, has destroyed our ability to trust our fellow humans. There I go again on my high horse, sorry, but I think you see my point. How can we regain our humanity, that we have lost while treating humans? I would like to think it is possible again, and better with advancements and the like....

Sorry if this doesn't help, but thanks for the indulgence of mind. Good luck!

Your father seems like a paragon of virtue in a time long past - a little Marcus Welby and a little "Doc" from the film, Field of Dreams. The kind of problems you are describing, however, are those of transition from a set of small town values and social arrangements to urban, industrial (post)modernity in which "corporate" values dominate.

I'd be careful of nostalgia, however. Of course, the things you describe were part of the reality of the time (you don't give actual dates) but I lived through the late 1940s, the 1950s and so on, so I'll take my direction from that era). It was what you describe, but it was also a place where abortion was illegal, homosexuality was (sequentially) a sin, a crime and a mental illness, and African-Americans drank from separate water fountains in public parks. It was a time in which we were instructed to fear immanent nuclear was and encouraged to find "Commies" under various beds. Remember, for example, that even on Andy Griffiths' much revered TV show, no "Negroes" lived in Mayberry, his allegedly typical, bucolic North Carolina home. In fact, only one African-American appeared on the show ... ever, and he was just "passing through."

What's the big problem? I'd say it's corporatization or "late capitalism" (call it what you will), of which the loss of "our humanity" is only a symptom. A wholesale cultural shift is needed away from the "neoliberalism" or "social Darwinism" (call it what you will), for which Mr. Obama's "reforms" barely scratch the surface. I am a Canadian (but I have lived significant chunks of my life, working and studying, in the USA) and I can attest to the fact that the ideology or values (ciwyw) of a society are best expressed in how the institutions of that society define human relations. Canada isn't much better, but we are moderately less devoted to the kind of possessive individualism that is endemic in your republic.

So, I wouldn't worry as much about matters of "bedside manner" and "house calls" (though I recall them fondly too). I'd start working for a single-payer, universal health insurance system in which private companies were not permitted to exist, a strongly regulated pharmaceutical industry in which diseases weren't invented to make markets for new drugs, and so on. Once the financial motive for a medical system based on greed, high tech investment, bio-medical models which all but ignore prevention and health promotion are in place, the niceties of good manners will probably follow.

Of course, to achieve what I'm suggesting will take some time and will be more than a little difficult ... but it has taken half a century to destroy the Marcus Welby's of the world and replace them with health "industry" leaders whose MBAs outnumber their MDs ... so get ready for a real battle. (We did it back in 1961, when Saskatchewan Premier (cf. US state governor) Tommy Douglas (grandfather to Keifer Sutherland, if a popular culture reference will help) took on the whole medical establishment and introduced the first "socialist" medical care system in North America which became, incrementally, the law of the land beginning in 1968.

Try it! You'll like it!

But, above all, please understand that it is larger structures of authority and power that determine most of what goes on in person-to-person settings. The kind of humanity you and I both endorse is, undoubtedly with noble but few exceptions, simply not possible in a private, for-profit setting. Authentic human decency, as opposed to carefully rehearsed public relations tropes on a par with the admonition in fast food outlets to "have a nice day" do nothing for the "bottom line"

Medicine is a vocation and it’s hard to even think of an inhuman or inhumane doctor. At the same time, medicine is a business, not just because of commercialization, but because of limited resources, the need for productivity and performance, and accountability.

Over the years, medicine has shifted from service towards consumerism. Again this was not brought on just by private medicine or managed care, but by patients themselves. In general, patients want to be consumers. A cheap and quick fix, free choice with decisional power, and a redress for compensation are often preferred.

None of these characteristics are intrinsically bad but they do make doctors feel as if they are technicians and tend to make them inter-personally detached, and medical practice becomes a transaction.

Having said this, health cannot be achieved without humanity. It is hard to strike a balance between consumerism and humanity. Despite difficulties, doctors should be caring and seen to be so. The challenge today is in becoming a good doctor and not just a doctor.

Re: It’s hard to even think of an inhuman or inhumane doctor.

Over the years I encountered many doctors who had total disregard for their patients' opinions. This is not just bad manners, but also quite dangerous. It is borne of an arrogance, a kind of superiority, perhaps because of their social status or silver spoon upbringing.

I recall an old patient, a retired construction worker, asking a doctor to check his leg, because it was painful. The doctor snapped "There's nothing wrong with your leg!" "But could you please have a look", the man said. The doctor snapped back "How many medical schools have you graduated from?" The old man looked him in the eye and said "None, but I've built a few."

Unfortunately most people are not able to stand up to abusive doctors, especially when they're patients in a hospital.

Humility is something they don't teach in medical school...but should.

Hi, Alan. Yes, many doctors are arrogant. What I meant was it’s painful (re: hard …) to contemplate the bad examples. Doctors tend to self-opinionated and I have come across many horror stories. It’s not just patients who suffer, but some consultants abuse their juniors and some doctors disregard their colleagues too.

I’m not sure which comes first, the chicken or the egg. Does medicine attracts people with big ego, or do doctors get corrupted by power? I think part of the problem is the old tradition of medical apprenticeship where like produces like. Fortunately, nowadays medical school has more refined selection criteria, and consumerism puts more emphasis on patient-client satisfaction. However, consumerism brings a different set of problems.

The best way forward is to train doctors in skills that foster patient-doctor relationship.

At the risk of seeming inhumane, if given a crude choice between competence and conviviality, I'll go for competence. After all, I don't go to see a doctor because I'm looking for a new BFF, but because something is wrong and I want it fixed. Of course, I am not blind to the fact that a physician is more likely to be able to make an accurate diagnosis and a suggest a helpful therapy if she is not a complete jerk (i.e., can take a decent clinical history) and I also know that narcisissts tend to let their egos get in the way of their assessments and treatments. So, I hope that I will always have access to medical professionals who are both good at what they do and are also good people.

As for kindness and caring, we do well to remember the words of Daniel Drake M.D. (1785-1852): "Medicine has been defined to be the art or science of amusing a sick man with frivolous speculations about his disorder, and of tampering ingeniously, till nature either kills or cures him"; however, as accurate as that comment might have been a couple of centuries ago, I'd like to believe we've come some distance since then.

As a three-time cancer survivor who drives a 1992 GMC pick-up truck, I appreciate that a doctor is not (entirely) like an automobile mechanic whose competence regarding internal combustion engines trumps rude attitudes and disrespectful actions every time ... but, I want both of them to get the practicalities (whether a cancer or a fouled-up carburetor) right. As a patient, I am not mainly interested in being "amused."

I'm not sure conviviality is the right word. It's more like empathy, which is necessary not just to make the patient feel good, but to take the case properly and get correct information.

Aside from doctor issues, there are probelms inherent in the way hospitals are run. Having worked in a major hospital for 4 years what I saw was :

1. No respect for the healing power of sleep - Hospitals are noisy places and patients are awakend constantly for trivial reasons. It weakens them further.

2. The food is ten years behind nutritional knowledge. White bread, sugar, etc. No sense of what to feed a person who is weak. Eg. Someone in a debilitated condition will get a hamburger.

3. Over medication - I recall a nurse trying to give my mother a cholesterol lowering drug. I said "Her cholesterol is normal to low - she's a vegetarian for 40 yrs." She said "Everybody get it"

4. Patients who ask questions or refuse a drug or treatment are labeled as trouble makers and treated even worse by the nurses.

5. No one listens. That's why medical errors kill 100,000 people a year. When I was admitted to an E.R. once, I told the doc taking the case that I was allergic to aspirin. Ten minutes later someone walked in and tried to give me aspirin. Hospitals are essentially towers of babel. Docs and nurses fail to read the charts and they miss all kinds of details.

6. There is the implicit assumption that patients don't know anything about their own health, or they wouldn't be in bed.

Yes, of course, "empathy" is the proper word; however, it is too often confused with a kind of superficial, chronic cheerfulness or, worse a banal commitment to a "positive attitude" that ends up being about as sincere and as helpful as the admonition by fast food dispensers to "have a nice day!"

As for your #5, an "investigative" report broadcast on television by the Canadian Broadcasting Corporation last night stated that iatrogenic illnesses acquired in hospitals were the fourth largest causes of hospital deaths in Canada, and that about 8% of all people admitted to hospitals are done some harm during their stay. The big problem? Contracting out cleaning services to private sector providers who hire low-paid, untrained workers to do the job. Such people (understandably) have little or no pride in their work and little or no ongoing relationship with their workplaces. So, to save a few dollars by employing non-unionized temporary workers, the "bean-counters" lose many times that amount in added costs due largely to the spread of infectious diseases, to say nothing of the harm done to patients and visitors (cf. the SARS epidemic a few years ago).

Hi, Alan. You have raised some very good points about healthcare in general. Sometimes basic things can achieve the maximal impact. They certainly fit in with the 20-80 rule.

Your observation is also correct in that suboptimal communciation is the greatest cuase of patient dissatisfaction and a potential cause for adverse otucomes. In one of the institutions I work with, we give detailed training to doctors in listening and in conveying empathy. This illustrates the importance of these skills.

Hi, Howard. I agree with you that competence is a fundamental requirement. To me, a doctor should be competent in both technical as well as communication aspects. Research has shown that having one and not the other is just not effective for the patient, nor for the doctor.

As for your comments regarding hospital infections, cleaniness is another basic thing with big impact; just like the ones listed by Alan above. And these basic things are relatively cheap. So it not so much about "bean counting", but more about good managenent. Having said this, it's not easy given the reality of limited resources and having to distribute it equitably, and making it worthwile (not just financially) for the institution.

I agree fully that a clinician should manage a case not only with medicines but also with humanity. I am sure the scenario will change over a period in view of emerging interest in human rights. CR Revankar.NewJersey

Humanity is first doctor is next. Disease in humans is the collective result of continuous onslaught on body, either by pathogenic organism, or pathogenic process

In either of them it is the individual who is affected.

A new born baby born with hydrocephalous is suffering for no cause.

Humanity in a doctor is existing in every form.

Money is the base for anyone to survive, and doctor is no exeption, humanity lies in understanding the disease and the ability to decrease ones suffering in the easiest and painless way.

Arrogant, egoistic, doctors, do exist, but there are many who live for the humanity in a doctor.

Oh heck, why not throw in Confucius, Plato and Zorba the Greek?

Somehow putting Nietzsche and Einstein (never mind Siddhartha) together in same paragraph stretches ecumenical elasticity to its limit.

And linking all of this to a putatively empirical screening test for empathy puts the whole project past the breaking point.

As I said in a previous comment two-and-a-half months ago, I do not seek out a surgeon in order to feel warm-and-fuzzy; I am interested in finding someone with technical skill. I also don't care much about the motivations of health-care professionals. For all I care, they can be aesthetically wooden, emotionally stunted, bad-tempered, narcissistic and chronically ambitious dolts. What I do care about is whether I will be cured of my disease or at least stabilized and made comfortable if no remedy is available.

Come to think of it, cold, emotionless, arrogant know-it-alls are precisely the sort of people I treasure when a steady hand on a scalpel is required. If, on the other hand, I am suffering only from the sting of a wasp or the common cold, I'll be open to soothing words and a gentle touch. Likewise, I'd appreciate a measure kindness should I one day be locked up in a hospice.

My point? Humane treatment may, but does not necessarily require people who somehow pass other people's test of what constitutes "empathy" or "humanity" or good table manners.

Actually, apart from relatively minor surgeries in my childhood and youth (tonsillectomy at 5, appendectomy at 17), a couple of broken bones, chronic monitoring for irregular atrial fibrillation since 2001, a modest bout of skin cancer, the removal of couple of dozen pre-cancerous abdominal polyps, etc., I had fairly major (is there any other kind?) emergency brain surgery at 56 and prostatectomy at 64 - a combined seven hours or so on the table - need I go on?

That's why I privilege technical skill over "bedside manner." It's not that a kind face and some friendly words aren't pleasant; but, given a choice between skillful jerk and the bearer of incompetent compassion, I'll take the jerk. Of course, an incompetent jerk is another matter.

Come to think of it, what I find most important is my universal, publicly funded health insurance - otherwise, my other points would be moot.

life is boring without relationships. Look what happens to a man when he is comforted, consoled, and reassured so that his/hers problems will be adressed. Doctor is not God to remove suffering but only an agent to comfort man. one may be a good doctor, but try also to give one or two comforting words, afterall you are also human, and the same can happen to you.

I think that the problem is in part cultural (anthropological) and in part technical. Who is a man and a woman? if we are a complicated ensemble of cells and tissues, with a brain computer, then the question of a humanistic medicine has no sense. From a technical standpoint I think that modern medicine for cultural (Cartesio etc) and economical reasons (prevalence of drug companies) has developed a too reductionist approach and unfortunately now we have no methods to develop a more humane system of diagnosis and of therapy. A "humanistic approach" to patient is always possible, but INDEPENDENTLY of the common diagnostic and therapeutic protocols. This is the reason why I dedicated my research efforts to the attempt to rationalize and validate the homeopathic approach, where the METHODOLOGY of remedy selections REQUIRES attention to the whole person. I don't want to maintain that this is the only way, but this is my way. I would like a integration of homeopathy in mainstreammedicine without prejudices.