"Nice doctors kill people," the surgeon told me, apropos of a question I'd directed elsewhere.
He explained: when doctors spare their patients pain by skipping tests or aspects of the physical exam that are uncomfortable, they end up harming the very people they'd set out to help. And he has a point: If you don't palpate an abdomen because your patient has belly pain, you could miss a surgical abdomen, and your patient could die (this resembles something that happened recently on the pedi ward, although I don't think that death was preventable; but that was the version of events that happened in the responsible resident's head).
But I wondered: can't you be nice and competent at the same time?
Sometimes I think, yes, of course, the best doctors are those who are nice and who listen and explain things clearly and give an encouraging smile before leaving the room. With something as complex as health, in which the power of the mind is startling and patients' outcomes have more than a little to do with their attitudes, being nice may actually heal.
But, I do understand his point. And the more I work with surgeons, the more I get it: being nice doesn't take you very far if it means you skip more tests or spend less time learning about more effective treatments and procedures or pay less attention to the detailed nature of your daily tasks. There's only so much time for learning and teaching in one day. If you're the average patient, you don't want a doctor who will scream at you, but you really don't want a doctor who doesn't know enough to perform procedures well.
So, while you can always be nice, and there's no justification for flat-out aggression, there probably is some trade-off between niceness and competence.
And it might just be that I've spent the last two weeks walking amongst them, but I'm feeling more like an asshole surgeon every day. What do I need to know before walking into the OR-- the name of the patient, or the name of the procedure? Well, it would be nice to know the patient's name, but as a surgical student, what's more important is the procedure. And I kinda like working with assholes: at least you know where you stand, and you know you can push back and have that be perceived as strong rather than pushy.
This probably has a lot to do with my background of being a nice person with a focus on the more behavioro-psycho-social aspects of medicine. Coming from a place in which surgeon is a dirty word (a figurative place, that is; wouldn't want to implicate of my previous places of learning), I can only be pleasantly surprised by the surgeon's perspective as I learn to adopt it. Competence, after all, is what any patient wants more than anything else that his or her physician might offer.
So, another realization in the road to medical knowledge, and another goal: to find the right balance between competent and nice.