Soft Skills

The art of medicine. Human factors. Communication skills. Soft skills. A multitude of names representing the same thing; the non-clinical side of medicine. Perhaps the most important yet least emphasized side of medicine that exists. These are courses and lectures taught in various medical schools today. I thus recall being surprised and more so upset when I heard a colleague (that too, a consultant) tell a patient in such a matter of fact tone, “Its a tumour. Very big and…” while staring intently at the ultrasound screen and pointing it out to the medical students and doctors crowded around him. Not the patient. Him. Not once did it cross this doctor’s mind to think about the words he used. About the surrounding (a busy and full emergency department with other patients right next to the one he was scanning). Most importantly, about the patient. The expression of that patient will never leave the recesses of my mind.

We live in an era where it takes the top grades to get into medical school. Where those who ‘binge and purge’ information from textbooks and lectures have a much likelier chance of gaining entrance into Medicine. Have we got it wrong? No doubt Medicine requires a certain level of intellect but shouldn’t that intellect come with the ability to show compassion? I was once told that the words, ‘patient’ and ‘compassion’ share a common Latin origin, ‘passus’ meaning ‘suffering’ or ‘burden’. The patient is the one suffering with a burden of illness while the lively and compassionate physician is the one who alleviates that burden, lifting it when possible. What use is a doctor who simply knows all the facts? Who only treats the disease and not the patient? As Dr. Abraham Verghese so eloquently put it in his talk at TED, what has happened to grand rounds? Where consultant and team attend to each patient, one by one. Where a rapport and level of trust is built over time between doctor and patient. Where medicine is taught at the bedside, in the physical presence of the patient and not the ‘iPatient’, a term coined by Dr. Verghese to illustrate the way rounds are often conducted today. In a room with a computer, tablet or some other form of device representing the real patient laying in the bed on the ward.

In our haste to pride ourselves with the latest technology, we seem to have lost the ability to appreciate the importance of soft skills. Of basic courtesy. Of being able to read our patients. Of realizing that often our patients are there to unload stresses, concerns and worries that may be completely unrelated to their diagnosis. And unless we pride ourselves with having good bedside manners, how can we expect our medical students of today to be compassionate doctors of tomorrow? Not practicing these ‘human’ attributes is one thing. But not understanding their importance is another. It astounds me to see the reactions of students whom I have observed over time when I say to them that there are examiners who may fail them based just on their interaction with the patient. From as simple as not introducing oneself to not having the courtesy of standing up and greeting a patient as they enter the room are unacceptable in my humble opinion. I often find myself relating students the story of one the brightest minds in my medical school class. In a mock exam, my classmate could not have done any better than he did from an academic standpoint. As the patient walked out of the room, my classmate thanked her, escorted her to the door and was extremely polite on bidding her farewell. You can imagine his disappointment when the examiner turned to him and said, “What was the patient’s name?” only to receive a blank look to which the examiner responded, “You would have known if you had asked. Fail.” Now perhaps I am being unjust to my classmate as he has always been and continues to be from what I hear, an amazing physician with bedside manners that would make a pauper shopping in Harrods feel at home. My point however, is to emphasize the basic level of courtesy some expect that far outweighs any ability to read a scan, regurgitate a classification system or know the treatment of any and all diagnoses that exist.

We learn many basic skills in medical school such as conducting a thorough history and complete physical examination, and I never wish to understate their importance in the practice of medicine. We also see a paradigm shift over the last few decades with an addition of lectures and tutorials attempting to strengthen the tie between patient and physician – the relationship in which the vulnerable patient places their complete and utmost trust in us. We as physicians should do our utmost to maintain and respect this – we can start by going back to the basics.