Essay: Alarm Bells

Jun 30, 2015

Patients often judge their doctors on their bedside manner.  But doctors also pay attention to how well they get along with their patients. But as Lake Effect essayist Dr. Bruce Campbell explains, it’s for reasons patients might not realize:

He is the happiest person in my medical practice, and every visit is full of his non-stop banter.  As soon as I walk in the room, he is off  and running.

"Hey, Doc! How ya doin'? Look at how beautiful  this scar healed up! You did a fantastic job! Man, I LOVE this place! Remind me to tell  you about that great story I heard! Did you lose some weight? You look great! Give me some more good news!"

I laugh when I hold up my hand, but he keeps right on going. Had we first met socially rather than because I was his cancer surgeon, I realize we might have been good friends. During each office visit, I can expect stimulating conversation, new stories about his family, and a shared confidence or two. I really enjoy his appointments.

And that worries me.

There are a couple of reasons for my concern. First of all, physicians need to provide care with Justice. All patients who come to us, whether we like them instantly or not, deserve the same quality of care and attention. It's clearly unethical to spend more time with a patient simply because we like them.

Secondly, despite the fact that physicians should care deeply about the health and well being of all of their patients, the therapeutic relationship is not based on “friendship.” Physicians must be objective and vigilant in ways that friendships can disrupt.

Someone at a famous medical center once told me, “It often seems that the worst medical care is given to VIPs and to doctors’ families.” She was implying that there are risks when friendship or hero worship  enter the physician/patient relationship. Corners might get cut. Potentially embarrassing but critical questions might not get asked. Treatment plans  might be altered.

My easygoing, friendly patient sits grinning at me. Being around him is fun, but the alarm bells go off in my head. I keep a "safe" distance, keep to my checklist, and try, once again, to overlook how much fun it is to see him.

Lake Effect essayist Bruce Campbell is a head and neck cancer surgeon at the Medical College of Wisconsin. He also writes about his experiences in a blog called "Reflections in a Head Mirror."