As patients, we’ve probably all seen doctors we thought were better and worse at their jobs. I met my favorite doctor in graduate school. During my first appointment with her, she remarked with excitement, “Oh, you’re a PhD student — you’ll get this!” and then took the time to carefully provide a detailed explanation of a procedure she was recommending.
But what exactly is it that sets apart the “good doctors” from the ones who leave a less-than-favorable impression? To find out, Stanford psychologists Kari Leibowitz and Alia Crum and I recently collected stories about patients’ healthcare experiences. It turns out what seems to matter most is whether your doctor exhibits the right mix of medical know-how and investment in you as a person.
In a survey, the findings of which were recently published in Frontiers in Psychiatry, we asked 334 adults in the U.S., from a variety of racial/ethnic and socioeconomic backgrounds, to explain what a good and a bad doctor meant to them. First, we asked survey participants to describe the positive characteristics that their ideal doctor would possess: Imagine what a good doctor would be like. What good things would this doctor do? What good qualities would this doctor have? This helped us understand what participants were looking for in a dream doctor, whether or not they’d ever interacted with one who checked all the boxes.
Then survey participants reflected on their own, real-life healthcare experiences. First, they indicated whether they had ever seen a good doctor. If they said yes, we asked what was good about that doctor. In addition to learning about the platonic ideal of a doctor, we were able to get a sense of what appealed to participants about doctors they’d actually seen and liked.
In our paper, we suggest that provider competence and warmth are the key “ingredients” in patient-provider interactions.
Their responses revealed a few common themes. Many descriptions — of both ideal doctors and good IRL doctors — concerned whether doctors seemed to “get it,” i.e., whether they demonstrate medical proficiency, knowledge and skill. For example, patients depicted the ideal doctor as one who would be “up to date with newer medical studies.” One patient described a good doctor they’d seen as one who “had a good knowledge of his field.” Others described doctors who were thorough, attentive and had a good work ethic, such as one who “looks at any and all alternatives” and “would follow up on small concerns.”
The other good-doctor descriptions reflected considerations of whether your doctor seems to “get you,” i.e., whether they demonstrate personal engagement, an interest in connecting and a commitment to patient care. Patients shared stories about good doctors who “had genuine concern about my well-being” and “listened to what I was saying.” Many of these stories emphasized the importance of being treated as an individual — for example, doctors who “treated me as a person, not an illness” and “asked me questions about what was going on in my life,” like my doctor who acknowledged that outside the exam room, I had a life as a PhD student.
These examples all fall into the categories that the psychological literature on social perception calls competence. That includes qualities like intelligence, ambition and skill (the “gets it” aspect of medicine), and warmth, meaning qualities like friendliness, empathy and kindness (the “gets me” aspect). In fact, research suggests that these are two key dimensions that we pick up on when we first encounter any new person.
In our paper, we suggest that provider competence and warmth are the key “ingredients” in patient-provider interactions. The example I shared of my favorite doctor captures both dimensions. She made it clear that she got me as a patient: She remembered something I had told her about my personal life (that I was a PhD student) and seemed to change her behavior toward me accordingly. By giving me a thorough and clear explanation of a complex medical procedure, she also showed me that she got it. Because she demonstrated both of these qualities in tandem, I trusted this doctor more than others I’ve seen where those qualities were less apparent. (A close runner-up for my favorite doctor was one who insisted on meeting me in person before I made an appointment for surgery, saying that he likes to get to see who his patients are before conducting an operation on them. Again, this highlights how important it can be to feel like your doctor sees you as an individual rather than just another body in the operating room.)
Of course, when it comes to displaying competence and warmth to patients, one size doesn’t fit all. Providers could communicate both qualities to patients in many ways, and what works for one doctor or patient might not work for others. My doctor taking extra time to explain a procedure was great for me. Some patients might not be interested in so much scientific detail, or might prefer a doctor to realize they have a child sitting in the waiting room and just get to the point.
As another example, touching a patient on the shoulder might feel genuine and help communicate warmth effectively for one provider, whereas for a different one, it might seem like an unnatural gesture and thus make the patient feel less, rather than more, comfortable. Ultimately, what appears to matter for healthcare is that patients perceive providers as both “getting it” and “getting me” — regardless of how they get there.
A large literature suggests that when we expect to get better, we actually improve in response.
Our research also suggests that not only does exhibiting competence and warmth make patients view doctors favorably, it could also influence the effectiveness of medical care. My colleagues and I ran one study in which volunteer patients received treatment for mild, lab-induced allergic skin reactions. Patients had stronger (positive) responses to treatment, we found, when it was administered by providers who displayed high levels of both warmth and competence.
This finding is supported by a few other recent studies in which patients were more responsive to treatments when providers connected with them socially (see here, here and here). Not only did the positive experience I had with my doctor make the task of managing a health issue far more enjoyable than usual, but it might have increased my confidence that the treatment regimen she chose for me would work well. In turn, my enhanced expectations about treatment might have led me to exhibit more healing after medical care, since a large literature suggests that when we expect to get better, we actually improve in response. The placebo effect is the classic demonstration of this phenomenon.
Given these findings, patients might consider whether a healthcare provider seems to embody competence and warmth when choosing where and from whom to get medical care. Finding a doctor with both of these qualities could make trips to the doctor’s office less stressful and more satisfying. And the very same medical treatment might even have more of an impact when it’s administered by a doctor who seems to “get it” and “get you.”