Why are some doctors so emotionally distant? Maybe it's the economy.

I've got a good doctor, and one of the reasons I like him as much as I do is his "bedside manner"—the shorthand we all use for describing whether or not medical professionals are able to connect with their patients emotionally. But pulling off a good bedside manner isn't just about being kind and empathetic, it's also about time. Part of why I think he had good bedside manner is that he spends time talking to me when I go in for an appointment. He answers questions. He asks about my life. He takes the time to empathize, even if, sometimes, that means that a problem that could have been dealt with in 5 minutes became a 20 minute appointment.

It's hard to make people feel valued and cared about if you've only got a couple of minutes to see them before you have to move on to the next person. Unfortunately, packing as many patients into a day as possible is more efficient in a business sense. A 2005 study of 11 doctors found that they spent an average of 13.3 minutes on each patientif you combined both face-to-face time and time spent working directly on the patient's case outside the exam room. The next year, anesthesiologist Peter Salgo wrote an op-ed in the New York Times about the pressure put on doctors by hospital administration to see as many patients as possible and move them on through with conveyer-like efficiency.

Now there's a new study that suggests the pressure to behave in a business-friendly way makes doctors more likely to have a brusque bedside manner.

What is behind the chronic compassion deficits of some doctors, managers, police officers, school counselors, and other "bad news bears?" Why do they express so little appropriate emotion and invoke such costly wrath? Andrew Molinsky, a professor of organizational behavior at Brandeis University, set out with researchers at Wharton and Harvard business schools to answer such questions. They found a wealth of scholarly research indicating that, in general, people feel and behave less generously when reminded of the pressures of the business world.

the researchers suggest that exposure to business world terms activates a profit-and-loss morality that unconsciously deadens a person’s emotional responsiveness and diminishes that person’s ability to conduct sensitive conversations.

You can read the rest of Rebecca Coffey's write-up on this study at Psychology Today.

The study itself is behind a paywall, but you can see the summary online: "The Bedside Manner of Homo Economicus"

Image: Electronic Stethescope, a Creative Commons Attribution Share-Alike (2.0) image from taedc's photostream


  1. I think I can agree that “brusqueness” is one of the characteristics of “poor bedside manner”, but I don’t think that “good bedside manner” is necessarily “making an emotional connection”. Maybe my view of this is warped by lowered expectations (doctors in this country are allotted appointments in 10 minute intervals – roughly 7 minutes of facetime and 3 minutes of paperwork per patient) but I’ve always felt that my doctor had great bedside manner and he’s never once asked me a question that wasn’t related to what was wrong with me. I think it’s less about connecting as people and more about helping to allay a patient’s fears and having an attitude of wanting to help them become well, as opposed to finding symptom a and prescribing pill b for disease c.

    My dentist is fantastic at this – to everyone who feels like their dentist doesn’t help them look after their teeth but just patches them up when things go wrong, I promise that there really are good dentists out there! Mine likes to have me hold up a mirror and show me where I’m not brushing properly, and was happy to show me on x-rays of my teeth where problem areas were. That made all the difference to me, making me feel empowered to look after myself. And he was even state-funded, not private practice.

  2. Of course if we want our doctors to spend more time with us without making any other changes to the American medical system, we should expect healthcare costs to rise even more than already predicted.

    1. Unless spending time actually leads to better outcomes in which case it could decrease costs. (I have no evidence either way)

  3. In the book Blink by Malcolm Gladwell he quotes a study that shows that doctors who spend more time with their patients are less likely to be sued for malpractice. The assumption was that patients will not sue doctors that they like and patients like doctors with good bedside manner.

    If someone has that study I’d like to see the “purely economical” analysis to see if doctors actually make more money by spending less time with their patients when the risk of additional malpractice suits are factored in.

  4. My wife was recently in the hospital, and everyone was great. The anesthesiologist, surgeon and her regular doctor visited her before and after the procedure. They didn’t linger or hang out like we was all buds or anything. They explained what was going to happen, answered all of our questions, and followed up afterwards. No more, and no less, time than was necessary to put our minds at ease. We never felt rushed or like a cog on an assembly line.

    Aside from my wife’s regular doctor, we did not seek out or vet the other doctors or nurses. Just whoever was on staff when she was admitted. It’s not hard to find good care, and I like to think that nearly all doctors and nurses are competent, caring, and efficient.

  5. Wouldn’t it be nice if we had a modest surplus of doctors in America, and they were paid a big fat GS14 salary, and they earned nearly as much as specialists, and they paid off their student debt by serving the poor,and they could afford to spend 30 minutes with every patient?

    But I suppose that would be islamocommunofascism.

    1. That’s a complete fairy tale. If physicians use intuition, it’s intuition about lab tests and other diagnostic criteria, rarely patient responses. And good output rarely equals good input. In fact, they’re frequently opposite qualities.

        1. No, but I’ve worked with several thousand of them. And unfortunately, been a patient with several dozen of them.

      1. Disagree. I’m a pediatric nurse who works with some great colleagues. Sometimes providers make “intuitive leaps” that turn out to be very valuable. I believe it’s the person processing small signs or contradictions in the back of their mind, when their conscious mind might not be noticing them outright. But everyone knows that when an experienced provider says, “Something’s not right here,” or “I’ve got a gut feeling about this..” you pay really good attention. 

        1. I take back the thing abut intuition being a fairy tale.  It’s the notion that intuition is tied to charm that I have a problem with.  And even a doctor with a complete absence of personality may be a good listener and pick up clues from the patient, the nurse or even the cleaning lady.

  6. I’m blessed with a great primary doc.  He is very busy but he always finds a way to squeeze you in if you need to and he focuses on you once you are with him and always listens.  If he recommends something or disagrees he will make sure you understand why.  He doesn’t like to toss pills at everything if he can help it but will check anything that seems suspicious.  When he sent me for emergency surgery he even stayed late that evening to personally check up on me in radiology.

  7. Many doctors do have a brusque personality problem.

    In some respects this is an adaptation to “needy” patients who if allowed might take up hours of a doctors time with demands for reassurance and a sounding board for complaints couched in the language of medicine.

    The only accepted place of “needy” patients in medicine is psychiatry which  I’ve heard described by some doctors as being paid to sympathetically listen to complaints for 50 minutes.

    While brusqueness may be necessary to avoid becoming entangled with a “needy” patient, many doctors can come across as assuming that all patients are needy as the default case.

    This is similar to when the police start with a basic assumption in their interaction with civilians that they may be armed and dangerous escaped felons.

    1. The only accepted place of “needy” patients in medicine is psychiatry which  I’ve heard described by some doctors as being paid to sympathetically listen to complaints for 50 minutes.

      You may want to be careful when you characterize anyone sees a therapist as a needy nutjob who just wants to complain for 50 minutes. It makes you sound like an asshat who has been privileged enough to never have to deal with mental illness (your own or someone else’s) and never had any serious personal tragedies happen to you. In fact, in makes you sound like the sort of asshat who is so privileged he/she doesn’t even realize or believe or care that stuff like that happens to other people. 

      Basically, your attitude reflects poorly on you. 

  8. I can’t remember the study, but it found that medical school has a bad effect on empathy and a doctor in Canada is getting doctors to re-learn empathetic skills through the arts (or something of that nature) it seemed to work well too.  Other than that many doctors are overworked which makes it hard to be understanding with patients.

  9. I think it’s a professionalism problem. The best doctors I’ve seen didn’t necessarily spend a lot of time with me, but they would intensely focus on our conversation, giving it their full and undivided attention. It’s a professional art, a way of performing that’s not all that dissimilar from a good waiter or salesman or plumber. It’s hard to blame med schools for focusing on the scientific aspects of medicine, but I think some doctors forget that their profession is a service profession. 

    1. …I think some doctors forget that their profession is a service profession.

      No. No. No. No. No. You do NOT want your doctor focused on ‘service’. You want a doctor who knows how to fix your body. You want the doctor with the most obvious Asperger qualities if that’s the doctor who’s most qualified. Nobody is good at everything, and your empathetic physician might be a shit clinician. In fact, that’s quite common.

      Evaluating physicians based on bedside manner is like buying a car because you like the color without even bothering to find out any of the specs. Except in the case of the physician, people actually believe that’s a rational way to make a choice. It isn’t.

      1. Hm. Are you sure you know what that word means? Doctors, in the final analysis, are glorified auto mechanics. But I understand what you are saying – I too would prefer an obnoxious plumber who was a talented perfectionist to the nice, friendly guy who never seems to finish the job.
        However, relating to Maggie’s original post, I think there is no reason why any doctor can’t have a decent bedside manner. It’s a skill that simply requires focus and concentration.To put it another way: people aren’t pipes or automobiles. Making a person relaxed and at ease WILL help them recover. It has been clinically proven that stress will make you sick and will inhibit the healing process. If a doctor can’t be bothered to learn some basic techniques to reduce stress in his or her patients, what does this say about the doctor? 

        1. If a doctor can’t be bothered to learn some basic techniques to reduce stress in his or her patients, what does this say about the doctor?

          It says that they have other, more important skill sets. Ones that will save your life. This emphasis on customer service in medicine is part of the toxic philosophy that says that everyone you encounter needs to treat you like a special snowflake.

          I worked in hospitals for 20 years. There were doctors with great bedside manner who constantly received praise and publicity and awards. And not one other doctor or nurse in the hospital would have considered going to them for healthcare. In surgery at least, the most brilliant physicians are sometimes profoundly socially inept, probably have an ASD and aren’t going to ever develop a bedside manner. And every other doctor and nurse in the hospital would go to them for healthcare.

          If you want to be soothed, buy a teddy bear. If you want good health care, ask a bunch of clinicians whom they recommend and don’t complain if he or she has no discernible personality.

          1. Fair enough. If a neurosurgeon was going to be inside my brain, I’d want the best, even if he’s ten times as obnoxious as Dr. House.

            You have a lot more experience than I do in this field, that’s clear. What I find interesting is that you almost seem to be suspicious of doctors that have a Fabulous Bedside Manner. Or perhaps you’re just frustrated that, while people love love love doctors that stroke them and make them feel better, as someone in the profession you have realized that such behavior has zero correlation to competence? In fact, you seem to feel that it tends to have a slight inverse correlation.

            I can see this being true. I had a wonderful surgeon who was an anal retentive asshole. One of the older nurses in the hospital told me that’s who you want – the surgeon who demands that everything be exactly right every single time, and are brutal to the staff otherwise. Not great for the staff, but very good for the patient.

            I am curious what you have observed – you are obviously frustrated with the way ordinary people evaluate their doctors. 

          2. you almost seem to be suspicious of doctors that have a Fabulous Bedside Manner.

            No, I’m saying that there’s very little correlation between good bedside manner and clinical expertise, and if it exists, it’s only in specialties like pediatrics.

      2. “You want a doctor who knows how to fix your body”

        Ideally, but even today medical knowledge is very limited in this regard. Many illnesses don’t have a “fix” and a large part of medicine is and has always been a combination of the placebo effect and the body’s ability to heal itself.

        Don’t underestimate the interaction between a good bedside manner, its positive impact on the placebo effect and good outcomes.

  10. Different strokes for different folks.  I’m not the type of patient who wants to have the doctor inquire after every little thing in my life unless it is relevant to why I’m in his office that day.  Other people may want that connection.  I’m on as much of a schedule as the doctor is, and don’t want or need to take up either of our time unnecessarily.

  11. In 20 years in the business,  I knew some brilliant doctors with absolutely no people skills and some not-so-brilliant doctors who were charming.  I know which one I’d pick to do my surgery.

    1. I am a nurse on a labor & delivery and mother/baby unit.  I work with OB/GYNs (who are surgeons) and nurse-midwives.  For my own prenatal care, I chose the nurse-midwife group because I liked how they seemed to actually listen to their patients more.  However, when I had to have a c-section after several hours of labor, I did not care about the bedside manner of the doctor, I just wanted to make sure it was someone who knew their stuff.  I had my daughter on the same unit I work on, and you can bet I asked my nurse who the on-call docs were that day as soon as the c-section issue came up (and if one particular doctor had been on, I would have demanded that she not come anywhere near me with a scalpel).  After that, though, I went back to the nurse-midwife practice.  I wanted a surgeon to operate on me, but I do not want a surgeon for routine care.

    2. You’re implying a false dichotomy. Not only are not all doctors surgeons (at least in the sense of surgery being the primary focus of their practice), but I work in healthcare and I know a lot of surgeons who are great, empathetic people. 

  12. I think a lot of people are missing the point here, it’s not about whether your doctor likes you or not, the pressure to increase profit has demanded increased patient load, lowering quality of care. Critical services like health care just simply shouldn’t be captive to profit-motive…

    1. Ding! Maybe I should have characterized this better. I like my doctor because we get along well, but the key to his bedside manner is evidence-based medicine. He’s actually told me this (one of the other reasons I like him is that he discusses evidence and research in-depth). He talks to people because studies show that produces better health outcomes over the long haul. He talks to people because studies show that doing so is more likely to give him the information he needs to catch problems early or notice factors that aren’t apparent if you’re doing conveyor-belt medicine. 

      1. We latch onto the things we feel are significant because of our worldview, but we can truly miss things that may actually be pertinent to the issue. You laid your position out fine, I would argue that we are now culturally blind to the the notion that “makin’ money” isn’t the best measure of success for all things (or many things for that matter) so your message just went in one ear and out the other.  Tough nut to crack, but you’re going to get a lot of practice recognizing and addressing this quirk with your work on environmental and social issues. 

  13. “Now there’s a new study that suggests the pressure to behave in a business-friendly way makes doctors more likely to have a brusque bedside manner.”

    Paging Ric Romero, Holmes has a message for you at the White Courtesy Phone.

  14. Spend your day dealing with overweight, uncooperative, and lazy patients, most of whom make bad life choices. Mix in patients who end up dead for all of the above. Add a large mix of dealing with insurance weasels who only care about denying every service and medication they can think of. Oh, and up their malpractice coverage into the statosphere. Talk to a Doc from Canada or Europe or any civilized country and you’ll find a happy caring doc who’s patients feel the love. We are the only industrialized country stupid enough to have a for profit health care system. Wake the fuck up.

  15. Maybe one of the reasons that doctors have such lousy attitudes is because that they are overworked AND overpaid. Yes you can be overworked and overpaid. Here is what I mean. The aging population coupled with programs like medicaid and medicare not to mention state run programs like MediCal have caused millions of people to regularly go to doctors.  This may seem like a good thing, however since people with insurance do not tend to look at the final costs of care when going to a doctor, this tends to cause people to use doctors more often. This wouldn’t be a problem if we had a fairly young and fairly healthy population like we did 30-40 years ago but today we have a huge number of elderly and obese people.  Diabetes is the number one debilitating disease today.  Couple that huge increase in demand with very little increase in supply. Yes the number of doctors have increased over the past 30 years from 1.6 doctors per thousand to 2.7 per thousand today. However that increase doesn’t go far enough to deal with the demographic changes and the changes in how medicine in paid for in this country.  Simply put, if you want doctors who are have better attitudes, there needs to be more doctors. 

     Half of all doctors today cite burn out from overwork at their number one concern.  Overworked doctors are not happy doctors, no matter how much they are paid. The solution is to encourage the AMA and accredited Medical schools to allow more students to become doctors. It has been an open secret for many years that the AMA maintains such stringent requirements to keep the number of practicing doctors low.  Fewer doctors would generally lead to higher income for those doctors.  Such is the law of supply and demand. However if the number of doctors is so few that they are overworked then the quality of medical care is sure to decline in spite of the rising costs.  This is the hallmark of any government regulated industry.  High costs and low quality.   Not that government regulated medicine has to be bad or expensive. In countries that have single payer systems in place, most have much higher ratios of doctors to population resulting in happier doctors, better care and lower costs, in spite of it being a government monopoly.  So If you want better medicine, we need more doctors.

    1.  The doctors that people are talking about (primary care doctors) are absolutely not overpaid.  As a matter of fact, the reason there’s such a shortage is that it’s financially almost impossible to keep a primary care practice open these days.  It’s only going to get worse with the new crew, who are coming in a quarter of a million dollars in debt, and will recognize that they can’t get out of the hole by doing primary care.  Keep your eye out for the huge influx of plastic surgeons and dermatologists.

  16. And psychiatrists? The reason why I proffer adding them to the list is because of what “Samuel Shem” went through in medical school…you know? The guy who wrote House of God? If you’re into books about people becoming a doctor that is a must-read. World-renowned anthropologist Melvin Konner went back to Harvard to get his MD and wrote a pretty good book on it, _Becoming A Doctor_, and noted that many of his fellow students were reading House of God. 

    I think it was in Konner’s book: when you or a friend or family member has to have surgery pretty quickly after diagnosis, ask one of the nurses who work in the Operating Room who, among all the surgeons that work in that hospital is called “Dr. Death.” Because there are some surgeons that just don’t have the right stuff. Creepy! If it’s not in Konner, maybe it’s in one of Richard Seltzer’s books?

  17. The medical system has become a voodoo system.  Good for giving you antibiotics for an illness that doesn’t respond to them but clears up on it’s own.  End result: voodoo medicine has cured you.

    Actual complex illnesses they do not do so well at. I am now up to a count of six people I know well with chronic undiagnosable conditions.  For a more complete picture of the medical profession watch Mystery Diagnosis where people are told  it’s all in your head or they are faking it until after 5 or ten years they are finally diagnosed. 

    The village medicine man does not like being told his juju is not working, he believes he is god.

  18. These issues have been around for a long time, and only gotten worse. Solo practices in the US are the most difficult, because one doctor’s billings typically have to support a nurse, a billing specialist, a receptionist, an officer manager to keep track of the nurse, the receptionist and the billing specialist…

    But this study sounds like it’s mostly about doctors in organizational contexts, who ideally would have less pressure to churn through patients. Except that their quickness goes directly to the organization’s bottom line.

  19. It’s older than that. Perhaps it has something to do with Osler’s famous essay on equanimity http://www.medicalarchives.jhmi.edu/osler/aequessay.htm written back in 1889. He actually was a rather positive force in reforming and advancing the education of doctors, but back then doctors could do little except let diseases run their course and watch an awful lot of people die.

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