Keeping Arrogance Out of the Exam Room

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Those who watched professional wrestling in the early 1990's (or those who'll admit it) likely remember colorful visions of Hulk Hogan, Jake "the Snake" Roberts, and a whole host of other memorable characters. One they may not remember, but who comes to immediate prominence in this writer's mind is a guy named Rick Martel. Martel was a great wrestler, with a good physique and a chiseled face…but the crowd hated him. He'd tromp to the ring wearing his patented purple trunks, stopping only occasionally to flex his biceps, sneer or fling condescending comments at his competitors. When given a microphone, he'd unleash a stream of insults on everyone around him (paying spectators included) and would even brandish a bottle of his own cologne, (humorously branded Arrogance) and would spray it into the eyes of his opponents to blind them. All the while, Martel maintained that he was god's gift to wrestling, that his competitors were "beneath him" and that because of his good looks, he didn't deserve punishment.


Now, how in the world does this wrestling anecdote relate to healthcare? It really doesn't…but arrogance? Now there's something we can talk about.


Better Than You

Arrogance, at its very core, is a belief that an individual is somehow inherently "better" than others. This belief can manifest itself in various ways, whether it’s through a perceived superior intellect, skill-level or social standing, but the overall principle remains the same: arrogant people treat others poorly and condescend to those they perceive as "beneath" them.


When we stop to consider those in society who exemplify the characteristics of arrogance we often go to the tabloid racks which showcase celebrities, athletes and politicians parading their wealth around and then acting like errant children when called to account for their mistakes. Still, these are people with which the majority of us will never really encounter unless we seek them out on TV, the internet or a supermarket tabloid rag. Do we deal with arrogant police officers? Arrogant teachers? Arrogant doctors? Possibly.


In the healthcare world, patients are becoming increasingly more informed. They have more access than ever to health and wellness information and they can share said knowledge and findings with other patients all over the world. With the proliferation of physician rating sites, they can even rate their individual visits for all to see. When patients have a bad experience, or an axe to grind, they can take to those sites to air their personal complaints. Among other quibbles (long wait times, unhelpful admin) a complaint becoming more and more prevalent on these sites is that of an "arrogant doctor," and it's a charge that can tarnish any physician's reputation.


What Physicians Do

Now, I'm certainly not of the belief that physicians are inherently arrogant, though I know there's bound to be a bad apple in there. I believe the very opposite. Those who commit themselves to medicine, commit to heal and treat the afflicted in society, aren't necessarily pre-disposed to any mindset that puts others beneath them. Words like "humble," and "compassionate" come to the forefront when we describe our ideal physicians, and the visions of tireless physicians, selflessly dedicating themselves to the healing of others have become fixtures throughout history.


The reality is that patients often only get a quick interaction with their physician, one that doesn't go far below the surface. When a physician deals with a backlogged schedule, fights fatigue or has to quell an unruly waiting room, patients only see the tip of this iceberg. As rating sites show, physician are often graded on their personality, as much as their medical competence. In turn, any number of actions, no matter how innocuous, can come across as arrogant, even if a physician is just experiencing a moment of weakness.


Here are a few simple strategies that physicians can employ that will not only help them keep their cool in tough situations, but will also help in communicating with patients and emphatically snuff out perceptions of arrogance.


Setting the Tone

No matter what, physicians are responsible for setting the tone of their practice. Whether it's by hiring excellent waiting room staff, investing in technology or choosing the physical location of their practice, all of these factor in to the overall tone of the patient's visit.


Subsequently, a physician's mood upon beginning a visit can also profoundly affect what a patient experiences. Even in times of extreme stress, physicians can set the feeling of the visit simply by their vocal tone and cadence. They can create this ambience by beginning their visits with a quick formality. Shaking the patient's hand, a quick introduction and a calm and reassuring tone only takes less than a minute, but goes a long way in clearing the air from the last appointment, and sends a message to the patient that you're there to help them and have their best interests in mind. Stressed physicians hurriedly moving patients through their office will only come across as detached and uncaring. Though physicians can't always control the figurative fires that start in their office, but they can certainly control the mood which surrounds them.


Respond to Concerns, Not Personal Assumptions

Patients often have questions of their physicians, especially when they've just been given huge amounts of information. When physicians use jargon or quickly rattle off list of side-effects, it can come across as dismissive or unimportant, making the physician appear unfeeling. Instead, physicians should directly respond to the patient concerns, always seeking to ensure the patient understands. It goes without saying, but even those medical things that have become routine to veteran physicians aren't necessarily routine to patients who expect sensitivity when undergoing these stressful encounters.


Additionally, responding directly to the question, no matter how "inane" it may seem, demonstrates humility and empathy, key components in creating a doctor-patient connection, and for patient compliance down the road.


It's OK to Acknowledge Restraints

Some days just don't go according to plan, and the physician's practice is prone to daily obstacles. In these situations, it's OK to acknowledge these limitations and even to apologize for them. "We've got a busy waiting room today, thank you for your patience," isn't a sign a weakness, but a humanizing bridge that patients can relate to, and appreciate. Patients are perceptive, and when things are out of whack, there's a good chance they've picked up on it already and will appreciate the forthrightness.


Always Explain Why

When prescribing a treatment, it's always important to explain why the particular course of action was chosen. Simply sending your patient off with a recommendation of surgery or a hastily written prescription may make for a quick and easy visit, but won't exactly help a patient trying to make sense of their newly discovered ailment. Just as any great debater knows that an argument must be backed up with supporting details, so too should any treatment regimen. When a patient knows WHY they're doing what they're doing, they're likely to exhibit more compliance, and will see their physician helping them, not just dispensing sterile and emotionless medical advice.


Solid explanations also help in those unfortunate times when physicians must openly disagree with their patients. Perhaps a patient suggests a treatment they read about online or opts not to heed a physician's advice for personal reasons. While physicians should never grow aggressive or confrontational with their patients, they are obligated to provide their best, most competent judgment on any matter. Wary physicians will not defer to bragging ("I went to medical school. Just listen to me!") and will maintain a calm and instructive tone while providing their own insights. Patients may not agree, but there's never any need for a patient to feel subjugated or small because they lack medical credentials.


The Customer is Always Right…but is the Patient?

Not always. However, patients are entitled to receive sound, practical medical advice from their healthcare providers, and they deserve to receive it respectfully and without condescension. To quote KevinMD contributor Eric Van De Graaf MD, "It is simply not allowable to be impolite, mean, nasty or snippy with staff or patients even when you are in a stressful situation." Not only does a calm and unwavering delivery reduce tension, it will also do wonders for patient satisfaction scores, and ultimately, the health and compliance of the patient.


Unlike professional wrestlers, physicians need not wave the American flag or bench press a school bus to gain the approval of their constituents. They can avoid the charge of arrogance by calmly and respectfully delivering information to their patients and most times a handshake, a smile and a "how can I help you today?" are all good starts to getting there.



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            Whole Health Chicago. Web. 24 June 2014.


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            Handle Us When We Do."

            Get Better Health, 5 July 2012. Web. 24 June 2014.


Kane, Leslie. "The 'A' Word: Are Doctors Arrogant?"

            Medscape, 17 June 2014. Web. 24 June 2014.


Tarkan, Laurie. "Arrogant, Abusive and Disruptive — and a Doctor."

   New York Times, 1 Dec. 2008. Web. 24 June 2014.


Van De Graaf, Eric, MD. "Why Are so Many Doctors Total Jerks?"

   KevinMD, 12 Aug. 2012. Web. 24 June 2014.