From Doctor, an Overdose of Kindness

By ABIGAIL ZUGER, M.D.

once worked with the nicest doctor in the world. She was a true marvel of kindness and dedication. Day or night, her patients could reach her for anything, and they adored her. She was their friend, their advocate and their savior, grieving at every mishap from divorce to pneumonia, and rushing to heal their pain.

Advertisement

There was just one little problem. She was a spectacularly bad doctor.

Presumably, at some point she had been competent enough to pass the usual exams. Once she was licensed, though, waves of kindness and sympathy had evidently flooded all but a few remnants of medical judgment right out of her brain.

She never said no to anything. When a patient wanted an antibiotic for a cold (a treatment useless at best, dangerous at worst), she cheerfully handed it over. For infections that actually did need antibiotics, she generally gave two or three.

She addressed other problems with the same inaccuracy and abandon. If a symptom could be due to X, Y or Z, she immediately treated all three alternatives, so patients would feel better fast. When she did order diagnostic tests, she often as not picked the wrong ones. When problems persisted, she prescribed more pills and ordered more tests.

She was far too busy to read journals or attend meetings to stay up to date. While patients waded through her peculiarly tangled and archaic work-ups, she dosed them up with pain relievers, antidepressants and sleeping pills, which often brought on problems of their own.

Watching her at work was an education in one of the most counterintuitive truths in all of medicine: the most sympathetic people do not always make the best doctors.

We hear endlessly about physician stereotypes at the far other end of the spectrum: the cold, science-obsessed automatons who know the facts inside out, but have yet to learn basic rules of courtesy, let alone some compassion for the aching flesh that keeps them solvent.

Most medical schools are now infusing their curriculums with courses in medical literature, ethics and even interviewing techniques, to try to soften these problem personalities a little.

What to do, though, when compassion runs amok? Untrammeled by judgment, knowledge or common sense, it can be a pretty scary thing, too.

A few months ago, I had to review a batch of hospital charts, and in two — shades of my old colleague — problematic niceness was at work. The patients had been hospitalized with abdominal pain, from a swollen liver in one, an inflamed pancreas in the other. Each was treated with a mild narcotic medication for pain, as is standard practice.

They were fine for a few days, and then began to complain of abdominal pain again. Their nice doctors increased the dose of pain medication. More pain. More medication. More pain. At the end of 10 days, they were on hefty doses of narcotics, and they were in agony.

The solution was supplied by a consulting gastroenterologist. The belly pain in each patient returned because of the severe constipation from the narcotics. Less pain medicine immediately led to less pain. No harm done — or at least no major harm. Not that time.

I haven't seen my old colleague in years, but I think about her often. I know of no major disaster to befall her patients. Still, there were always dozens in the making. Should the rest of us have done something (other than roll our eyes, that is)?

But what? Is it malpractice to be too nice?

The medical profession may have a particular obligation to address this problem, because medicine's usual watchdogs — patients — often cannot. Patients are instinctively on their guard against hostile or uninterested doctors (and, studies show, more likely to sue them than more pleasant ones). But kindly doctors with smooth bedside manners can manage to provide vast quantities of substandard medical care, as other lawsuits often show.

On the other hand, though, people often need friends, advocates and saviors far more than they need doctors. They wind up in medical offices simply because they have nowhere else to go.

And my old colleague was more than the writer of misbegotten prescriptions; she had a true genius for helping people through their lives. You would absolutely not want her managing your heart attack, but no one would be better at holding your hand through the bad parts.

In the balance, did her hand-holding do more overall good than her pills did harm? Had all the niceness been trained out of her way back when, would her patients have been, in the long run, better off? There you have some medical questions no study is ever going to answer.