MEDICAL ARTS

One Doc, Two Doc, Red Doc, Blue Doc

By James Devore, MD

The cheese platter in Sutter Santa Rosa’s historic medical library was a perfect gathering point for an interesting assortment of doctors. You wouldn’t find a more unusual and diverse collection of species at a watering hole in the Serengeti. Sonoma County physicians were assembled for our annual Doctor’s Day reception—an event sponsored by the SCMA Alliance to honor physicians and encourage us to take better care of ourselves.

As I stood by the cheese platter wolfing down the Brie and trying to forget that my lipid profile had been sampled that very morning, I took a quick inventory of the curious hodgepodge of doctors present. They included a serious-minded traditional internist who surely must get out of bed wearing his Ivy League shirt and tie; an unreserved surgeon in fine Italian loafers working the room like a politician; a mellow khaki-clad pediatrician; a quietly intense anesthesiologist who seemed to be scanning the room for data; a gentle, soft-spoken ophthalmologist; a quirky and slightly ruffled pathologist … and on and on it went. Dr. Seuss could not have imagined a more unusual group.

Not that any of this should be surprising. In researching a book I am co-writing about the doctor/patient relationship, I have long been discreetly observing the enormous differences in doctors’ personalities and manner of delivering medical care. The impetus for this project came a few years ago, when I met my co-author Debra Skinner, a specialist in corporate leadership coaching and communications training. She spoke about the communication tools she uses in corporate settings, and something clicked for me. I was fascinated to learn about current research in personality types and how they relate to business and personal relationships in the corporate world. I was particularly interested in the Myers-Briggs Type Indicator, a psychological “tool” that can be used to understand the basic differences in how people relate to others, think, make decisions, and gather and organize information.

Using Myers-Briggs and other tools, people can be categorized into different types based on their natural preferences. To give only a few simple examples, you can be Introverted or Extroverted (are you energized by being alone or around others?); Sensing or Intuitive (do you prefer to get all the details, or do you first see the big picture?); Thinking or Feeling (do you make decisions with your head or your heart?).

What happens when we apply Myers-Briggs and other tools to doctors and the doctor/patient relationship?

When patients have a medical encounter, they have specific expectations about how the doctor should treat them; what they need from the visit and how information should be delivered; and, most importantly, what qualities the doctor should exhibit.

Problems occur when these expectations are out of sync with the type of doctor they are consulting. Doctors are not all the same, and they certainly can’t be all things to all patients. Many frustrations and breakdowns in the relationship between doctors and patients come from not understanding these differences.

For many patients who have bad medical experiences, the problem isn’t a missed diagnosis or a mishap in surgery; nor is it because the doctor was inappropriate or uncaring. Instead, the problem is that the patient felt ignored or disrespected.

Some patients have the idea that all doctors in all circumstances should be warm, friendly and compassionate. When they come across a surgeon who is professional and efficient but somewhat distant, they are frustrated. Other patients expect all doctors’ offices to be sparklingly clean and tidy. When they visit the pediatrician and realize that the toys in the waiting area haven’t been sterilized in an autoclave, that the receptionist is munching a granola bar, and that the doc is wearing a slightly wrinkled polo shirt instead of a starched white coat, they are disturbed. Still other patients expect a doctor to evaluate their symptoms in precise and time-consuming detail, with a full array of diagnostic tests. When the doctor performs a cursory exam and recommends a better diet, more exercise and a weight-loss program rather than a million-dollar workup, they are dissatisfied.

Patients often fail to recognize how dissimilar doctors can be. The fact is that we physicians come into medicine from very different directions and bring different strengths and weaknesses to our profession. Yes, we all attended college, went to medical school, dissected cadavers, learned physiology and practiced examining each other. We all went through the prescribed hospital rotations in medicine, surgery, ob-gyn and pediatrics. With this rigor and similarity of training, it’s easy to assume that doctors share more than their MD or DO degree. It’s easy to take for granted that we have other qualities in common as well, such as temperament, outlook, point of view, behavior and personality. But that’s simply not the case.

Just for fun, I have broken doctors down into four different groups. To introduce the different types, I’ll admit ahead of time that I will engage in blatant stereotyping and oversimplification for clarity. Here are the four groups; see if you recognize yourself or some of your colleagues.

Rock Star types. They drive fast cars, wear finely tailored clothing, and tend to live on the edge personally and professionally. Their focus is directed at fixing things, and they thrive on the excitement of high-tech but often risky procedures. Staying up all night saving a life comes naturally; bedside manner does not.

Scientist types. They seek specialties away from direct patient contact. They love the science and challenge of medicine but don’t have a need for long-term relationships with patients. They tend to be creative, with a broad and less detail-oriented view. Patients might see them as a bit odd.

Professor types. These quintessential physicians tend to be soft-spoken, studious and thorough. They enjoy hands-on medicine and have a loyal patient base. They will rarely be found without a stack of medical journals on the front seat of their white, midsized sedan. They wear neatly pressed white coats, with a stethoscope draped over their shoulders.

Good Ol’ Doc types. These docs are often described as the most casual, amiable and empathetic of the physician types. They thrive on long-term personal relationships with patients. They dress in the same casual style for the office as they do for a weekend run to Costco. Their office looks more like a well-lived-in home, and patients call them by their first name.

For a simple example of how these types play out, let’s compare a Good Ol’ Doc pediatrician with a Rock Star orthopedic surgeon. The pediatrician is calm, mellow and unflappable as he goes about caring for his flock of little ones. He takes extra time to make each child feel comfortable, answers questions from nervous parents, holds hands, and gives prizes to kids who are especially good in the office.

In comparison, the orthopedic surgeon goes straight to the X-ray and then focuses on the injured knee–not necessarily the person with the injured knee. He takes extra time to do a thorough exam, and he orders an MRI to take advantage of the most sophisticated imaging techniques. During the visit he’d prefer you not disrupt him with idle chatter, questions, or the lengthy story about how you were cleaning the gutters and fell off the ladder and … stop! He doesn’t want to hear this.

Mysteriously, pediatricians tend to be small, slightly built and physically unimposing–perhaps they have evolved to work with kids closer to ground level. In contrast, orthopedic surgeons could play offensive tackle on the football team. They are big and beefy, with thick, strong hands ideally suited to pulling a dislocated shoulder back into its socket.

The pediatrician’s office is homey, cluttered and noisy, and it features exam tables and medical equipment that saw the polio era. The orthopedic surgeon’s office is sleek, high-tech and expensive, with the latest in computers, state-of-the-art supplies and digital medical records. At the office visit, the pediatrician sits back, chats with mom about Baby Susie’s “milestones” and her future as an environmental scientist. Meanwhile, the orthopedic surgeon keeps one eye on the X-ray view box and one eye on the clock as he tests the range of motion in the knee, scribbles off a prescription, and bolts out the door to the hospital.

Doctors in different specialties can be spectacularly dissimilar. And it’s not just their personalities that are different. The pediatrician and orthopedic surgeon in this example are from different corners of the medical universe–not just physically and personally, but also in the way they approach their patients.

Take another simple example of a patient with abdominal pain. One doctor–perhaps a Professor internist–might do a painstaking history and physical exam and order an exhaustive workup, leaving no stone unturned in her effort to pinpoint the diagnosis. Another doctor–maybe a Good Ol’ Doc family physician–might focus more attention on diet and job stress and be comfortable with a trial of medication and lifestyle modification as an initial step. There is no right or wrong here. It’s a matter of style, of preference, of personality. The Professor is no better or worse than the Good Ol’ Doc–just different.

Of course, this process is complicated by the patient’s expectations. Patients have distinctive types as well. Some patients want and expect a more detailed clinical evaluation and work well with doctors who provide that. Other patients are looking primarily for a personal, trusting relationship with their doctor. This expectation may result in a more collaborative wait-and-see approach that both parties agree makes sense. In both cases, the doctor’s perceived performance is largely the result of the expectation and desires of the individual patient. Different patients in different circumstances may find different doctors to be “the best.”

One specialist I use is a good example of this point. Some of my patients love his no-nonsense, direct and slightly offbeat style. They perceive him as a quirky but exceptionally focused and skilled physician. These patients love him. Others have a completely different experience. They see him as cool, aloof and sometimes blatantly unsympathetic. At first I thought these patients just caught him on a bad day, but that didn’t prove to be the case; it was simply their own perception of this doctor. These patients were looking for a more nurturing, personal relationship, whereas he was offering more technical excellence and less Kumbaya.

All these examples bring me back to the main point: Doctors are not all the same, and patients are not all the same. The key to more powerful doctor/patient relationships is for doctors and patients to recognize and embrace the differences that we all bring to this unique and sometimes perplexing relationship.

Back at the Doctor’s Day reception, I reluctantly left the cheese platter and worked my way over to the wine bar. I innocently asked the surgeon with the Italian loafers which wine he preferred. ”This Pinot,” he intoned, “is a structured wine that expresses layers of blackberry, minerals and sage. It is earthy yet aromatic …” Huh? I just wanted to know if I should try the red or white. I should have asked a pediatrician.

E-mail: devorej@sutterhealth.org

Dr. Devore is a family physician in private practice in Santa Rosa.