The Listener 9-15 Jan 09: No hypocritic oath

No hypocritic oath

BY LINLEY BONIFACE

Doctors have never promised to be nice - and, surprisingly, patients don't necessarily expect them to be.

Dr Gregory House is, by any standards, one of television's prickliest medical creations. Rude, aggressive and devoid of anything resembling a bedside manner, he frequently accuses his patients of lying about their symptoms and relishes putting them through painful and often unnecessary procedures.

Although House may be fun to watch on TV, you'd think viewers would be less keen to encounter a real-life version of the ornery medical detective. Not so, according to a new survey of patients.

In interviews with 109 patients from five general practices in the Bay of Plenty, most patients thought it was very important for a doctor to be knowledgeable and a good listener, and most thought it was very or quite important for them to have a good bedside manner and be "nice". However, if forced to choose between a very clever doctor and a very nice doctor, 69% said they would rather have the clever doctor.

The small survey, published as a letter in the New Zealand Medical Journal, was led by medical researcher Dr Shaun Holt. "I'm a big fan of Dr House," he says. "I think lots of doctors wish they could be as rude to their patients as House is to his."

Of more interest to Holt is the finding that a third of patients would rather have a nice doctor than a clever doctor. Although many researchers have investigated doctor/patient consultations, therehave been few studies into the basic question of what kind of doctor patients prefer. Holt was intrigued to discover that so many patients put more value on niceness than on clinical skills.

Holt believes some patients' preference for a nice doctor may help explain the popularity of alternative practitioners. He says there may be no scientific rationale or evidence behind some alternative health treatments, yet practitioners tend to have a good bedside manner and more time for their clients. "Alternative practitioners are often ridiculously nice, so people like them even if their treatments don't work."

Holt's interest in the nice versus clever issue was sparked as a medical student in the UK, when a man working as a doctor was found to have no medical qualifications. The bogus doctor gave dangerous advice — including telling patients to take a spoonful of toothpaste, pretty much regardless of what was wrong with them — yet when he was struck off patients wanted him back because he was so nice.

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