Balls and Walnuts
more than you ever wanted to know
On “Do Nice Patients Receive Better Care?”
The July 6 JAMA bears the above-named two-pager (written by Allen S. Desky MD PhD and Mark O. Baerlocher, MD) in their Commentary section. I’ll save you the effort and summarize: “Almost certainly yes, but it’s an impossible hypothesis to test.” The authors also conclude that we need to develop strategies to deal with this phenomenon.
Which prompts me to insert this quickie:
Seriously, guys, is this the best you can do? They actually provide a footnote for the sentence, “However, the majority of clinical care requires human interaction.” Please.
For me, two things stand out about this brief commentary. Both are interesting inasmuch as they seem to say more about the authors than the titular question. First, they include a paragraph wherein they wonder how a free market would handle the problem of not-so-nice patients, and speculate that a system in which such patients are unable to find care could lead to
what economists call “welfare increasing effects” (ie, making overall society better off by having the sum of the gains be better than the sum of the losses) from matching physician preferences to patients they call “nice”
but conclude that “regulatory and professional organizations could never endorse it.”
Okay, go watch that YouTube video one more time.
The Commentary’s second oddity? Their concluding sentence:
Pretending that this phenomenon is not so is probably not helpful, and raises the next question — is it wrong?
I’m having trouble reconciling my emotions on this point. (And I know why, too — because there is a fundamental mismatch between my professional ideals and the fact that I’m human.) On the one hand, I want to say, “I’ve got news for you gentleman. You doctors. You treat the public, and that includes the nasty, warty, petty public.” On the other hand, I realize what a hypocrite I’m being by making this statement. When I was in private practice, I tended to discharge anyone who was verbally abusive to my staff. Or who threatened to kill me*.
Here’s what I think we should do: (A) Study the question. It’s a valid question, and I don’t buy the authors’ argument that “nice” and “better” are well nigh indefinable. Sociologists define such concepts all the time. Devise assessments and validate them. If we can have a SNOT-20, we can certainly have tools that measures a doctor’s perception of patient niceness, and a separate metric for quality of care.
And (B), we popularize the results. Because you know that’s one hypothesis that’s gonna get confirmed. Let the public know that their behavior can affect their care, and at least some of them will make an effort to be nicer. And it’s a win-win for everyone: doctors’ lives will be easier, and patients will get better care.
D.
*Doesn’t matter that the threats didn’t seem entirely serious (one guy was in his 80s) — the cops told me we had to take all such threats seriously. And a guy has to have some standards, right?
I bet there’s a point, though, where being too nice gets you worse treatment. Too nice to complain about a genuine problem, too nice to get a second opinion, too nice to push for answers …
Perhaps that should be the study’s goal – to create a spectrum of niceness that will optimize treatment.
I would argue that it’s possible to be a good advocate for your own healthcare AND be nice, but I suspect some docs would disagree with me — the ones who churn patients, the ones who cringe when their patients come in with a written list of questions, etc.