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What does management theory have to do with being a good doctor?

A recent article authored by Sadati and colleagues entitled “From good to great physician: a critical ethnography based on patients’ views” describes patient perceptions of what great physicians are.1 This article is one of many reporting that the doctor-patient interaction is crucial in determining the quality of a doctor from a patient’s perspective. Not surprisingly, good doctors are those viewed as good communicators and who show respect for patients. These behaviors contribute to patient satisfaction, comfort, confidence in a caregiver, and may positively influence treatment outcomes. Unfortunately, the study conducted by Sadati and colleagues reminds us that despite many years of research consistently showing that key behaviors that communicate respect, honesty, forthrightness, and concern are extremely important,2 many doctors don’t seem to be listening.

This brings up the question of why? After all, why would intelligent people who dedicate their career to helping others fail to understand what is needed to interact with patients. The answer to this question is surely multifaceted and complex. One part of the answer may be explained by looking through a management theory lens.

In his book on management theory, Douglass McGregor suggested managerial decisions are rooted in conscious or unconscious assumptions about human nature.3 McGregor’s theories, dubbed Theory X and Theory Y were the first to consider how internal assumptions about people affected management decisions.4 Though these theories appear dichotomous, they actually exist on a continuum.

Theory X managers make authoritative decisions, micromanage, threaten punishment to motivate, and do not reward individual or innovative thinking. Decisions are based on conscious or unconscious assumptions that employees are lazy, not capable of self-directed work, require constant supervision, and avoid both work and taking responsibility whenever possible.

Theory Y managers tend to motivate employees through sharing responsibility, encouraging innovative thinking and participation in decision-making. These actions are based on conscious or unconscious assumptions that employees are not inherently lazy, enjoy sharing responsibility and being involved in decision-making, and provide valuable input.

Could theories X and Y similarly describe doctor patient interactions? For example, could doing little to explain a diagnosis or treatment be rooted in an assumption that a patient could not understand it? Could not involving patients in decision-making come from an assumption that patients don’t have the appropriate knowledge to be involved? Conversely, could including a patient in decision-making represent an assumption that they can and should participate? Is communicating information about a diagnosis or treatment based in an assumption that patients can understand it, deserve to know and participate in decision-making?

Poor doctor-patient interactions have been with us for a long time. It appears we are collectively not making much headway in improving “bedside manners.” Perhaps, on some level we sometimes fail to recognize assumptions we make about ourselves and those we serve.

1. Sadati AK, Iman MT, Lankarani KB. Journal of Medical Ethics and History of Medicine Original Article From good to great physician : a critical ethnography based on patients views. 2016:1-9.
2. Bendapudi NM, Berry LL, Frey KA, Parish JT, Rayburn WL: Patients’ perspectives on ideal physician behaviors. Mayo Clin Proc 2006, 81(3): 338-344.
3. McGregor D. The Human Side of Enterprise. Vol. 21, N. New York; 1960.
3. Warner Burke W. On the legacy of Theory Y. J Manag Hist. 2011;17(2):193-201. doi:10.1108/17511341111112596.

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