http://www.medpagetoday.com/PublicHealthPolicy/PracticeManagement/dh/2816

COLUMBUS, Ohio, March 8 - Television doctor Gregory House is winning
high ratings by being a rude, arrogant troublemaker, but he'd lose out
big-time on a new scale that rates an ideal doctor.

The best physician is confident, empathetic, humane, personal,
forthright, respectful, and thorough, according to a study in the March
issue of Mayo Clinic Proceedings.

House - played by actor Hugh Laurie as a limping curmudgeon who despises
patients but loves their diseases - fails miserably to meet most of the
standards, according to research conducted by Neeli Bendapudi, Ph.D., of
Ohio State and colleagues.

House is presented as a brilliant diagnostician, but his technical
competence wouldn't enter the equation, Dr. Bendapudi and colleagues
concluded, because most patients can't judge medical skill even after
they have been treated.

Instead, patients judge doctors on the basis of how they behave in the
clinic and office, the researchers concluded.

"Patients can sense if the physician is rushed, preoccupied, tired,
aloof, disinterested, or alarmed just as they can sense a physician's
genuine interest, compassion, calmness, and confidence," the researchers
said.

The study is based on interviews with a random sample of 192 patients
who were seen in 14 different medical specialties at the Mayo Clinic in
Scottsdale, Ariz., and the Mayo Clinic in Rochester, Minn.

The interviews, focused on the patient-physician interaction, lasted
between 20 and 50 minutes. Patients described their best and worst
experiences with a doctor in the Mayo Clinic system and gave specifics
of the encounter.

From those interviews, Dr. Bendapudi and colleagues extracted the seven
key attributes that would make up the ideal doctor.

Of the seven, the most mentioned was "thorough," the researchers noted,
while "empathetic" came up least frequently.

The study is one of the first of its kind and therefore valuable, said
James Li, M.D., Ph.D., of the Mayor Clinic in Rochester, but it has
several key limitations, including a lack of information about the
demographic characteristics of the interviewees.
Several studies have shown that minorities and women were more likely to
feel they got less-than-ideal treatment, Dr. Li wrote in an accompanying
editorial. "It would be informative to know more detail about the
interviewed patients," he said.

Other limitations, acknowledged by the researchers, are that the data
are qualitative and that the subjects were all involved with one
institution, which may limit the generalizabilty of the work.
However, they added, the study is exploratory and was not intended to
say anything about the "prevalence of phenomena." Also, they noted,
patients in the study had wide experience in the health-care system.

"Our respondents drew from a rich experience base when commenting on
Mayo Clinic physicians," they said.

Dr. Li added that health care can't be high-quality if physicians are
seen as hurried, disrespectful, cold, or callous.

Dr. Li said it's up to the medical community to find ways design a
health care system that encourages doctors to exhibit positive qualities
during the clinical encounter.

"A physician who pays personal attention to the patient -- who is
respectful, compassionate and competent -- that's what every patient
wants," Dr. Li wrote.

The authors introduced the concept of clue management which they feel
"may be a useful tool for transforming the broader behavioral themes
into discrete behaviors that positively affect patient perceptions of
the service experience." As an example, for the ideal physician behavior
of "thorough," the illustrative "humanic" clues would be:

Provides detailed explanations.

Gives instructions in writing.

Follows up in a timely manner,

Expresses to patient desire to consult other
clinicians or research literature on a difficult case.

As another example, the illustrative "humanic" clues for "confident"
would be:

Refers to state-of-the-art medical practices.

Refers to experience in treating specific medical conditions or
performing procedures.

Is not disturbed by patient's queries about medical information acquired
from other sources (regardless of accuracy or inaccuracy).

Is at ease in the presence of patient, family members, and medical
colleagues.