Have you ever asked yourself what you most want in a doctor?  Is it intelligence, competence, steady hands, a diploma from an elite medical school?  Perhaps you care less about such qualities and more about caring and compassion.

    I am a doctor and what I most want in a doctor is a combination of the aforementioned characteristics (with the possible exception of the elite medical school diploma).  In my clinical experience over the years I have come to the conclusion that what most patients need, more than anything else, is the caring and compassion. 

    For what good is a doctor who cares not for the patient as a person, who cannot sit down and listen? Certainly a physician who is not well educated or who appears to be incompetent is hardly the one any of us would choose, but I think most of us need someone who cares.  The caring side of medicine is, by far, more powerful than any drug.

    The idea that patients appreciate a physician who appears to care was poignantly demonstrated to me at work recently when, after receiving some rather bad news, a woman thanked me profusely and gave me a hug.  In fact, one of the most rewarding things about my job is the hugs I get from patients and families and, interestingly enough, it is sometimes after I have delivered unpleasant news.

    Now, I'm not suggesting that medical schools should teach their students that they should hug everyone who comes to the office or to the emergency room, but I do believe that overall there is too little emphasis placed on the healing potential of communication and human touch.

    The lady who gave me the unexpected embrace tonight was a 56 year old who came to the emergency room with simple urinary symptoms, or so it seemed.  Though urinalysis did show a bladder infection she complained of pain out of proportion to what one might have expected.  On physical examination she was found to have lesions typical of a serious case of genital herpes, a condition which is not only extremely painful but which carries with it social and emotional ramifications as well. Herpes is a sexually transmitted virus for which there is currently no known cure, though drugs can be prescribed, to provide comfort and to hasten resolution of the disturbing symptoms.

    I hate to tell anyone they have herpes. No one wants to hear that kind of news. Some people become angry and rather indignant and take their frustrations out on us who work in the emergency room.  One such man I encountered became very irate, demanding that the true diagnosis not be written on his chart.  Falcification of medical records is not a practice in which I engage.  Though patient confidentiality is a time-honored tradition, which should be upheld, the medical record must reflect the truth.  If one seeks as much anonymity as possible he might be better served by going to a private physician's office rather than to an emergency room where other patients and their visitors might overhear.

    Here, tonight I had a middle-aged woman who had never before had a sexually transmitted infection and who had, just one month previously, got married and I had to tell her she had herpes! It is a delicate matter dealing with such patients.  Not only is herpes incurable with present day medicine, but such news generally raises questions regarding the sexual partner and issues of fidelity.

    Eventually I met her new husband, who had a few questions of his own and though the ER was busy I felt it  imperative that I sit for a few more moments and discuss with them the woman's diagnosis.  Incredibly, when we were finished, the man  warmly shook my hand and thanked me.  Go figure!  What else, if not a perception of caring, would allow this couple to smile and give thanks?

    These thoughts regarding the humane side of medicine are in no way intended to detract from the qualities of integrity and competence which are also the hallmarks of a good physician, but if you are fortunate enough to have the opportunity to pick and choose your doctor from a number of potential candidates, you will be better served and the therapeutic potential will be greatly enhanced if you seek out and find one who possesses both clinical and interpersonal acumen. 

Marlene Buckler, MD, FACEP         www.StayOutOfMyER.com ;