CMAJ 2001;165(10):1376[PDF] Whither the good-natured physician with the Norman Rockwell smile?

Doctors attending the annual meeting of the Royal College of Physicians and Surgeons of Canada last month were asking that question after learning that by far the most common complaint against physicians is rudeness to patients. Meanwhile, one of the country's leading bioethicists says she's horrified by the "sense of entitlement" that is now prevalent among Canada's medical school students.

This arrogance is partly the product of a lack of recognition of the importance of "role-modelling" as an integral element of a physician's education, Dr. Nuala Kenny, chair of the Department of Bioethics at Dalhousie University, said in an interview. Kenny, who delivered the Royal College Lecture, said younger physicians often witness more seasoned colleagues acting short-tempered or using derogatory language. And like abused children who later become abusers, "if that's what you've learned, often that's what you've become."

Kenny added that medical school curricula and CME programs pay little more than lip service to ethical instruction, and even though notions of "compassion, truthfulness, humility, and altruism" are generally found in the rhetoric of medical education, "it's not in the life experience." Dr. Dennis Kendel, registrar of the College of Physicians and Surgeons of Saskatchewan, said the gap between a physician's and a patient's perception of the quality of care received seems to be widening as patients become increasingly savvy about treatment options at the same time as physicians face more stress because of heavier workloads. And this stress may be leading directly to patient complaints. In an interview, Kendel said an element of rudeness is now reported in a "very high proportion" of all complaints his college receives.

In the current environment "some physicians seem to become less tolerant of any sense of disagreement between themselves and patients. And yet there ought to be room for healthy discussion. If a physician recommends a certain approach and a patient is disinclined to follow that, that shouldn't necessarily result in the physician saying 'it's my way or the highway.'

That's increasingly what we're finding, that patients find themselves dismissed from practices because they didn't acquiesce completely to whatever the physician recommended." Kenny argued that medical education must evolve to include a more profound understanding of the issues that surround all health care encounters. "It may be your 50th trauma victim this week," she said, "but for the person who is injured it will raise profound questions," including doubts about the efficacy of different types of treatment. — Wayne Kondro, Ottawa