Social Skills for Doctors

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So... I'm an aspiring doctor, hoping to go to medical school starting next year. I understand the importance for good people skills, especially when dealing with patients, but I'm only just now realizing that I may be at an advantage for this reason too.

Earlier I found this article and it's gotten me thinking:
http://www.nytimes.com/2011/07/11/healt ... ral&src=me

What do you think of this article? It seems to me like they are almost intentionally trying to rule out "Aspie" candidates.

Do you think those on the spectrum can make good doctors? Should excellent social skills a prerequisite?

hope that school's the only one

Unfortunately, not. :/ It sounds like quite a few schools are adopting it, according to the article.

Be a trauma surgeon or a coroner.

I've had a doctor with AS and they did their job just fine. I prefer my doctors be well trained, prompt with test results, informative, and receptive to my health problems. They do not have to be social butterflies.

I see no reason for having excellent social skills. One should simply have sufficient communication skills and not upset their patients.

The mini interviews are designed to asses:
- how well candidates think on their feet and how willing they are to work in teams
- how well they respond when someone disagrees with them, something that happens when working in teams

Because:
- Candidates who jump to improper conclusions, fail to listen or are overly opinionated fare poorly because such behavior undermines teams. Those who respond appropriately to the emotional tenor of the interviewer or ask for more information do well in the new admissions process because such tendencies are helpful not only with colleagues but also with patients.

I think that the qualities tested in the mini interviews are not exactly excellent social skills; but rather tests for is high level, rapid objective thinking and dispassionate communication. And yes, I think these skills are important in doctors; don't you?



Assuming competition for limited spots in med schools, this sort of testing makes sense to me as a means to the goal of choosing the most talented prospects. I see this trend in medicine as a means for this profession to raise it's own bar and not as a means to exclude any particular spectrim.

I can see what you mean. Yes, I agree that those skills are important.

Equally so, though... group communication is not an area where Aspies typically fare well at, due to sometimes impaired social and communication skills. As the article suggests, however, those skills can be learned. If not, why bother with teamwork classes? That said, the students who could really use the lessons have already gotten rejected due to the interview process.

I don't think that this type of screening process will put an Aspie doctor in a very favorable light. They may not be screening out those on the spectrum specifically, and some will undoubtedly make it through the process, but it's not where they will shine, most likely. That's the impression that I'm getting.

That isn't to say that they can't make good doctors, though, when given a chance.

I have excellent listening skills, for example, and I care about people. I have a great deal of empathy. Yet I don't necessarily do well in groups for the reason that I'd rather hear what others have to say rather than jump to my own conclusions right away. If prompted for a response, I will answer, but I have trouble with getting my voice heard. I won't shout above a crowd of people. I will respond in turn if given the opportunity. People term this behavior as shyness, and that's how it'll probably appear to an interviewer, but more it's just that I like to weigh all the possibilities before I respond.

As for my problem solving abilities, I tend to prefer taking my time so that I can make the best decision possible. I can come up with a reasonable "quick" response, but I don't think that those decisions made under pressure and time constraints are always the best. There are medical specialties that reward careful planning and thinking and that's what I'd like to aim for. Sometimes quick decisions are needed and I should be able to do that. I just don't think that that method promotes the best overall treatment in all cases. There are definitely times when a "wait and see" mentality is preferred.

I guess my concern is just that these tests will weed out otherwise qualified candidates based upon limited information. But, perhaps that concern is completely unfounded after all... it's not like GPA, MCAT scores, or any other indicator are any better of an indicator of a candidate's readiness to be a doctor. Perhaps these mini-interviews really are a new and effective way to choose a future doctor. I really don't know. For now, I guess I need to give them the benefit of the doubt. When I actually make it through my own interview process, maybe I can offer more information.

I don't think they're intentionally trying to rule out Aspie candidates, I think they're trying to rule out insensitive people who are unwilling to think beyond first impressions and personal bias.

It sounds like the mini-interviews are less about "normal" social interaction than they are about demonstrating an ability to talk with another person about concrete situations in a logical manner--to exchange information and rationale for decisions or ideas as opposed to exchanging the kinds of small talk and social niceties that are expected in less professional interaction.

I think that there are a lot of things that can be called "social skills" .....the ability to listen is a social skill, and is just as important as the ability to speak up. I have a feeling that this school is more interested in people who have strong listening skills than people who are extremely talkative. Based on what you said about preferring to listen to what others have to say and about how you care about people, I bet you'd do just fine

Oh, and I think whether or not a person is an Aspie wouldn't necessarily affect whether they were a good doctor one way or another--it's more about who they are as a person, I think....I mean, the ability to use language and executive functioning skills would be a consideration, but if the latter two abilities aren't terribly impaired, then I think it's about the person more than anything else.

I am a physician and I am an Aspie. I should point out, however, that clinical practice only makes up about 20% of my work. The rest of the time I am engaged in health policy and commuity and public health program work.

I am a lucky Aspie--I am a quick, analytical thinker. I am adaptive and I learned a lot of coping skills in my extra-curricular pursuit of acting. (I often maintain that, "Children's Theatre saved my life.") I can turn on the people skills in a clinical setting--but it is very tiring because for me they are very much learned skills that must be conciously exercised. I have long since come to the conclusion that I am not well suited to 100% clinical work, not because I lack the people skills, but because maintaining those skills in a clinical work environment is simply too demanding. Fortunately not all medical practice is clinical practice and there are ways to be a doctor without spending all of your time in a clinical setting.

However, medical school and post-graduate training don't offer that same flexibility. You must follow the prescribed curriculum, and the system can often be singularly unsuited to accommodating needs. Medical education is intensely rewarding, but it can be gruelling for those who are ill prepared. If the schools that you are applying to offer the opportunity, please meet with students in all years of the program outside of the application process. You can have the chance to discuss what their daily and weekly lives are like--and be sure to ask about the down sides, and any particular challenges that you think you might have. There is absolutely no reason that you can't succeed in medical school, but you need to go in with an awareness of the challenges, and the flexibility to change your coping skills to match those challenges.

my mom has ptsd from doctors treating her sooo horribly. It really needs to change and I am glad something is being done about it.
I cant count the number of times a doctor has freaked out when my mom says she allergic to all antibotics and all steroids. She is...and they can kill her, but doctors treat her like she is psychosomatic when she says this. One doctor did not believe her and told her that "if you were running a 108 tempature and had an infection...I will give you antibiotics." This kept her out of the ER when there has been many times durring heart trouble that she needed to go. She says I am not going to die, some doctors "ooops".
Anouther doctor thought that doing a total masectomy would get rid of her allergic swelling...WHAT! that is insane! Dont forget the numerous times doctors have given up on her because she was "too complicated" like she was disposable.

She went to an aspie doctor once...he was very nice although short on chit chat which didn't bother her. The kind of people they are screening are total jerks who wont listen and put their ego before the patients needs.

Thanks for your post! It's very encouraging to hear from an official Aspie doctor. I've been feeling a little discouraged lately because it just feels like I'm not the typical medical school candidate. My heart's in it, and I want to do the best that I can, but it sometimes seems like I'm a little bit of a fish out of water. Being a doctor is definitely a little out of my comfort zone, but I'm equally convinced that it'll be well worth it if I can just survive the process.

My hope is that I can find some niche that allows me to do some combination of research, surgery, and clinical work... maybe even teaching, if I could get into some sort of academic setting. Socializing is tiresome, of course, but I can do it in short bursts. I hope it won't be too much of an impediment. Here's hoping!

Thanks for the response! I hope you are right about all of that.

Rereading the article, I think I misjudged it a bit. I think there is definitely a niche of information exchange and debate that doesn't fall into typical "social skills" but more just a category of general respect. That much I can definitely deal with.

I'm sorry to hear that your mother has been so mistreated by doctors. That's really a disappointment... It's a goal of mine to NOT to be like that. I know it's easy to judge right now and make big claims... I think most doctors don't set out to be bad at their job. It just happens. But I want to do the best that I can and actually listen to patients when they tell me something. This is a case where being very trusting can help and hurt, I guess.

I wasn't sure whether I should respond to this post, or not, but I have decided that I will. Your post raises a number of medical and medical-ethical questions that merit some discussion. I think it's also helpful to see that there is always a second perspective on things.

At the outset, it goes without saying that I am not your mother's physician, and I have never examined her, so I am in no place to opine about her condition. However, that being said, I find the claim that she is allergic to all antibiotics and all steroids to be too improbable to be credible unless she has some underlying immune system disorder. I do not doubt for a moment that she presents symptoms in reaction to these drugs, but I am highly doubtful that the cause of those symptoms is an allergic reaction.

It is important to distinguish between allergies and sensitivities. Many people are incorrect in their belief that they are allergic to something. An allergy is a specific type of immune systemp response that arises when the body produces an immunoglobulin-E (IgE) mediated response to exposure to an allergen. IgE binds to the allergen and to mast cells, which are the ones that release the mediators, like histamine, that cause the allergic reactions. So, no IgE mediation, no allergy. Further, a person never has an allergic reaction on first exposure to an allergen--that exposure creates the IgE receptors, but the allergic reaction will only trigger on a second exposure. Given the extensive number of classes of antibiotics (and the numerous drugs within each class), to expect that a person would present allergic reactions to all of them presupposes that the person has already been exposed to all of them. Finally, steroid drugs like hydrocortisone are immuno-suppressive drugs, it is counter intuitive to suggest that a patient has an hypersensitive immune system response to an immunosuppresive agent.

So what I suspect we are dealing with here are drug intolerances or adverse drug rections. That does not mean that the reactions are any less significant--but it might not be medically correct to call them allergies. As for their underlying cause, I would strongly suspect a psychosomatic cause.

All processes in the body are biochemical processes, so if a person was allergic to all steroids, then all steroids would cause those allergic reactions. But this is clearly not the case, because your mother is not presenting allergic reactions to the steroids that her own body is producing. Neither, I presume, is she presenting allergic reactions to the steroids that she is ingesting in her diet. When a patient has a reaction to an administered drug but does not react to the natural presentation of the same agent then we aren't dealing with a reaction specific to that drug, but rather to something else. Chemically, there are very few common features to all classes of antibiotics and steroids that are not shared by compounds occuring naturally in the body. Frankly, their strongest link is the artificial nomenclature that we have put on them.

You seem to be misunderstanding the term psychosomatic. Psychosomatic symptoms are not made-up or fake. Symptoms caused by a psychosomatic condition are real, measurable and clinically significant. From a medical perspective, psychosomatic reactions merit therapy, but they do not always merit the same therapy that the same symptoms from a different systemic cause would merit. Anti-anxiety medications or even placebo can be more effective at treating symptoms with a psychosomatic pathology than typical drug therapies.

As for the doctor who would administer antibiotics if she was running a fever of 108 and had an infection, we are now in the territory of medical ethics.

From a medical perspective, the doctor is absolutely correct. If a patient is febrile with evidence of infection, antibiotics are indicated. With a temperature as high as 108, they become absolutely necessary. This is a temperature at which brain damage can occur, and an infection of sufficient gravity to cause such a temperature will very likely kill the patient if left untreated. Even in a circumstance where the patient is clearly allergic to any antibiotic agent, the correct medical decision is to administer the antibiotics, and to administer therapy to counteract the allergic reaction. (Not to mention aggressive therapy to reduce the fever). When faced with an infection that will almost certainly kill a patient and an allergic reaction which is unlikely to kill the patient if treated while it is occuring, there is no question which is the correct medical choice.

But ethically, the decision lies with the patient--provided that she is competent to make that decision. A patient who refuses life-saving therapy on the basis of a drug allergy which can be managed raises a very serious question about competent, informed consent. I do not believe in heroic medicine at all costs. I sign off DNR orders at patients' request in many circumstances. But if I am ever in the slightest doubt about the patient's decision to refuse treatment, I will always err on the side of saving the patient's life.

I can't offer much comment on the suggestion of mastectomy to address allergic swelling. Your post does not provide enough detail to make any guesses. The way you put it, it is unreasonable--which leads me to believe that there's more to the history than simple allergic swelling.

But where this all arrives at the end of the day is the nature of a doctor-patient relationship. A dysfunctional relationship between doctor and patient is usually due to mistake on both parts--and I have been as guilty of mistakes with patients as much as any other typical physician. We are not perfect, after all. The most common mistakes that I have seen are doctors who forget that patients know their bodies best and patients who have preconceived notions of their medical conditions and refuse to accept advice from their doctors to the contrary.

So, what would I do if your mother presented herself to me and claimed to be allergic to all classes of antibiotics and all steroids? Well, to be perfectly honest, I would not believe her. I would believe that she has an adverse reaction to these classes of drugs, and I would believe that she was allergic to some of the antibiotics. But I would try to disabuse her of the preconceptions that these were all allergic reactions and that any administration of these drugs would be potentially life-threatening if undertaken with medical supervision.

But the system does not give me unlimited time to spend with each patient. In the time that it has taken me to compose this response, I would likely have seen as many as 8 or 10 patients. So how can I, in 10 or 15 minutes, convince a patient of the medical inconsistency of her beliefs?

They are not "beliefs". every antibiotic given to has caused severe anaphlaxis for 3-4 days...any steroid that have she has tried has caused nearly fatal reactions of swelling 3 times her normal size and major heart problems from processing all of that fluid. She was given a tpoical antibiotic and it ate 2 layers of her skin in 30 mintues. She has mastocytosis, a rare allergic disease. Her bloodwork shows positive for it.
Your attitude is same attitude that is wrong with medicine. Just because it doesnt happen often, doesnt mean it cant happen. Her mother died of a massive allergic reaction to a steriod shot...she was dead before they pulled the needle out. It seems to run in the family. The only reason this allergy is disturbing to doctors is because antibiotics and steroids are the halmarks of modern medicine. Had she said that she was allergic to all stinging insects...there would be no questioing her mental state, but because of her bizzare allergies to half of creation, then she must be delusional.

There's the missing piece of the puzzle. You will note my caveat, "unless she has some underlying immune system disorder," above. Well now you've presented a fuller picture that makes more sense to me. (I should point out that although mastocytosis presents symptoms that can be similar or identical to allergic reactions, it is not an "allergic" disease, and the mediation of reactions is often very different from true allergic reactions).

So what we are dealing with is not an allergy to all antibiotics and all steroids, but rather with mastocytosis. Mastocytosis is certainly going to present allergy like symptoms, but due to the excessive number of mast cells present in the body. In these circumstances your mother is vulnerable not only to antibiotics and steroids, but potentially to a whole host of stimuli.

This is a difficult situation to work with, but no phsyician would be incapable of establishing a therapeutic regime that addressed the acute condiction, while accommodating the underlying condition. My particular area of medicine is internal medicine (infectious disease), and I have dealt with patients presenting mastocytosis from time to time. In these cases, I have brought in an immunologist colleague, so that we can bring coordinated experience to bear on providing advice.



When did I ever say that it can't happen? I acknowledge that it did happen and very likely will happen in the same circumstances.

I have never suggested that your mother was in any way delusional. I have never had any doubt that she presents the symptoms in reaction to these drugs. Even if these reactions are psychosomatic (and psychosomatic triggers can be present with mastocytosis), that is not indicative of any disordered mental state. As I have said before, they are real, measurable and often warrant therapeutic action.

But what I am doing is not accepting your claim of allergy as a full and sufficient explanation of why she presents these symptoms. The issue is not what happened when she has been exposed to these drugs, the issue is why it happened. When we know why, then we can address the real problem, and not merely its symptomatic presentations.

Just because I do not accept a patient's belief that a given set of symptoms warrant a specific diagnosis does not mean that I don't believe these symptoms have occurred. But what it does mean is that I want to use the training, skill and experience that I have to treat what is actually disordered, rather than what the patient has assumed is disordered.