Bad Medicine: Overconfidence and customer service?

Intended for Healthcare Professionals

Bad Medicine: Overconfidence and customer service?

Eugene Y.H. Yeung, Medical Doctor, Royal Lancaster Infirmary, Lancaster, UK

3 May 2018

This article questions why reassurance can be considered bad medicine nowadays.¹ I think the real question should be whether overconfidence and customer service are bad medicine.

Twice the pride, double the fall. I have seen clinicians digging themselves into a hole by confidently making big claims. "Irbesartan is an ACE inhibitor." "Gram negative bacteria are all anaerobic." "Salbutamol nebs do not come in as 2.5 mg. I know for sure." These are just some of the wild reassurance I have heard in school and at work.

In contrast, good clinicians often have a back-up plan, in case their initial assessments are wrong. That is why physicians spend years of training to learn the art of differential diagnosis. Even for medical specialists, they must first go through years of medical schools to learn various medical conditions. We are not simply looking for evidence to prove ourselves right; rather, we are often playing the devil's advocate to see which of our differentials is the least incorrect. Does it mean increased cost and time for ordering additional investigations? It is not necessarily true, as good clinicians often have a stepwise approach on what investigations to order, and use "time to test" whether their hypotheses are correct.

Regardless, today clinicians are being judged by their "customer service" skills. Patients may have their own agendas on their visits, and can call you bad clinicians for not obeying their requests.^2,3 Reassurance can be wrongly interpreted as arrogance and poor listening skills.

There is no one-size-fits-all solution to communication breakdown and customer dissatisfaction. Some patients may feel relieved that you reassure they have no illness, whereas some demand you give them the investigations and treatment they want. Some clinicians could eventually give in due to fear of receiving complaints and losing rapport with patients.

If we simply reward demanding patients who make unreasonable requests, are we fairly treating everyone? Are we then deprioritising the gentle patients who stay quiet due to respect to our expertise? This may very well violate the bioethics principle of justice.

References

1. Spence D. Bad Medicine: Reassurance? Br J Gen Pract 2018;68(670):239-239.

2. Rosen R. Professional judgment v customer expectations. BMJ 2018;360:k1366.

3. Yeung EYH. Is the customer always right? BMJ 2018 Apr 7; cited [May 2, 2018]. Available from: https://www.bmj.com/content/360/bmj.k1366/rr-0.

Competing Interests: I have been paid for working as a medical doctor, but not writing this letter.

Main menu

User menu

Search

Bad Medicine: Overconfidence and customer service?

NAVIGATE

RCGP

MY ACCOUNT

NEWS AND UPDATES

AUTHORS & REVIEWERS

CUSTOMER SERVICES

CONTRIBUTE

CONTACT US