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I believe it was Clemenceau who remarked that we don't need air in our tires either but it sure makes for a smoother ride!

Posted by Wren Hunt at October 13, 2005 9:27 AM

British reporter: "Mr Gandhi, what do you think of western civilization?" Gandhi: "I think it would be an excellent idea." [Upon the occasion of Gandhi's first visit to the UK][Hope I got this right ... it's from memory.]

Posted by tom peters at October 13, 2005 9:37 AM

My favourite this month:

"Until one is committed there is hesitancy, the chance to draw back, always ineffectiveness. Concerning all acts of initiative (and creation), there is one elementary truth, the ignorance of which kills countless ideas and splendid plans: that moment when one definitely commits oneself then Providence moves too. All sorts of things occur to help one that would otherwise never have occurred. A whole stream of events issues from the decision raising in one’s favour. All manner of unforeseen incidents and meetings and material assistance, which no man could have dreamt, could have come his way.
I have learned a deep respect for one of Goethe’s couplets: "Whatever you can do, or dream you can, begin it. Boldness has genius, power, and magic in it.” - W. H. Murray

Posted by Trevor Gay at October 13, 2005 11:47 AM

Wren - brilliant quote, love it. I think manners matter, and that if something's worth doing, it's worth doing well, but just to redress the balance a little and acknowledge they're not the be all and end all: "Bedside manners are no substitute for the right diagnosis." Alfred P. Sloan, Jr.

Posted by Mark JF at October 13, 2005 1:02 PM

Mark JF, funny thing about your Sloan quote. For better or for worse, there is a bunch of solid research evidence that more or less says that quack docs with great bedside manner are seldom sued for malpractice. Docs with lousy bedside manner are disproportionately sued--even when there clinical skills are top decile.

Posted by tom peters at October 13, 2005 1:46 PM

Mark - I could tell you one stories about how good bedside manner aids patient recovery - regardless of the competency of the doctor. It is my specialist subject after 35 years in healthcare! There is no doubt however that Harold Shipman had good bedside manner - the evidence is in the public domain. He would have passed all the tests and got all the right ticks for his manners - but he murdered over 200 patients. Frankly if I need a heart transplant tomorrow the Doctor can have the manners of Basil Fawlty as far as I am concerned as long as he is competent and top notch technically. But when dealing with issues like mental health the bedside manner of the doc becomes crucial to the patient’s recovery. Tom is right - there is loads of evidence that bedside manner is important to patients recovery. Fantastic subject - I wish we could have more healthcare topics.

One quick story concerns the woman in Australia suing her Gynaecologist for some negligent treatment and when it got to court she was advised by her brief that it was in fact the fault of her Family Dcotor and not the fault of the Gynaecologist. She immediately withdrew her claim becuase she said she said she liked her Family Doctor. The lesson surely is how do we get some of the more arrogant but brilliant 'technical' doctors to learn how to speak to and listen to people. and thereby hangs a book :-)

Posted by Trevor Gay at October 13, 2005 2:09 PM

We ought to link this thread to the one about Mrs. Thatcher and the Tory leadership: Tony Blair has to be the epitome of great bedside manners but a mediocre doctor. Mrs. Thatcher was a brilliant doctor, it's only the manners that were a little lacking!

Posted by Mark JF at October 13, 2005 2:46 PM

Wonderful - that is 2-1 to you Mark :-)

Posted by Trevor Gay at October 13, 2005 4:44 PM

Trevor, agree. Effective "laying on of hands" is invaluable, though it goes far beyond the standard definition of "bedside manner." As I see it (non-technically), good "bedside manner" is about engaging the patient (a very good thing); "laying on of hands" (my stolen term) is about being a true healer of the spirit--which can make an enormous physiological difference. See the healthcare "chapter" in my Master presentation (Part 2); there is a more or less "movement" which involes a group I know called the Planetree Alliance; in my write-up I refer to their excellent book. A planetree, as you doubtless know, was as I recall the tree Hippocrates (sp?) propounded his medical dogma, such as "do no harm" (right?).

Posted by tom peters at October 13, 2005 5:26 PM

Thanks for that Tom – you are spot on. I will look up the Planetree Alliance - sounds interesting.

The spelling of Hippocrates is right by the way. Below is the classic version of the Hippocratic Oath – there is a modern version but there is something very powerful and indeed charming about the original don’t you think?

Note old Hippocrates does not mention cost effectiveness; evidence based medicine; or zero based budgeting in healthcare!!! – Just joking

From my own research about Hoppocrates I come up with the following;

He was born (around 460BC) on the Greek Island of Kos, and in the centre of the town is the Plane Tree where Hippocrates is traditionally supposed to have taught. He is regarded as the 'father of medicine.' He rejected superstition in favor of scientific observation. Hippocrates classified diseases and created a set of moral and professional standards for physicians. Primum non nocere ("first, do no harm") is a medical rule thought to originate from Hippocrates and another is Ars longa, vita brevis ("art is long, and life short")

Here goes with the Hippocratic Oath …

“I swear by Apollo Physician and Asclepius and Hygieia and Panaceia and all the gods and goddesses, making them my witnesses, that I will fulfil according to my ability and judgment this oath and this covenant:

To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art - if they desire to learn it - without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody who asked for it, nor will I make a suggestion to this effect. Similarly I will not give to a woman an abortive remedy. In purity and holiness I will guard my life and my art. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. If I fulfil this oath and do not violate it, may it be granted to me to enjoy life and art, being honored with fame among all men for all time to come; if I transgress it and swear falsely, may the opposite of all this be my lot.”

Posted by Trevor Gay at October 14, 2005 2:44 AM

Mark JF, disagree about Mrs Thatcher (80 today?). I think she had brilliant bedside manner. Moreover, I think it was better than her policy. I consulted regularly in the UK in the Wilson years. Brits were as about as depressed as those Muscovites I mentioned in a recent Post. Yes, Mrs T was indeed the "Iron Lady," but she also lived up to the Napoleonic "A leader is a dealer in hope." Reagan was kinder + gentler, but both of them bestirred their malaise-besotted masses.

Posted by tom peters at October 14, 2005 7:51 AM

Tom - fully agree on the dealing in hope bit and you can add vision, drive and ability to get things done, amongst others.

Regarding the "bedside manner" though, I think it might be one of those cases where people are perceived differently from afar than at home. For many Brits, including her fans (of which I'm broadly one), Mrs. T was seen as patronising, preaching and often talking down or at people. For people who saw her less frequently and often in more set piece situations, I suspect she came over differently.

Posted by Mark JF at October 14, 2005 9:54 AM

I agree, Mark. What I meant (and didn't say very well) was that it was her psychological forcefulness that made as much as or more impact than her intellectual (policy) might.

In doctor world, my main complaint is not with rude docs, it's docs on rounds who treat me as a detached piece of anatomy, docs who keeep their opinions to themselves as if I were not interested (or present at the examination), and it's docs who don't appreciate the degree to which I can be part of the healing process, the center of the wellness process. They may be technically proficient, but they lack the human touch, be it gentle or tough.

Thatcher did tough love, Grandfather Reagan did sweet (but equally "determined") love, Churchill (or Lincoln in our moment of greatest peril) was that rarity (as ever) who did both brilliantly and simultaneously. (Of course WSC was another example of a British premier loved more on the Western side of the Atlantic.)

Posted by tom peters at October 15, 2005 6:25 AM