When Does Confidence Become Arrogance?

Confident or arrogant doctor?

An orthopedic surgeon in the US wonders whether or not a physician’s confidence level impacts how a patient interprets their own treatment outcomes.

I have always practiced with a humble and self-deprecating style.  I think I do a good job, and as a surgeon am pretty good with my hands. I try to recognize my limitations.  I think I am an excellent critical thinker.  I think I am above average in my ability to counsel patients on issues – specifically talking them down from abnormal study findings that do not need treatment, and being honest about a clinician’s ability to aggressively manage diffuse and nonspecific pain complaints.  I don’t take praise well from patients, and feel a bit shy or flustered when someone is effluent with praise.

Sadly, the humble truth is often not what patients appreciate.  They want to hear how you have all of the answers and how you are going to “fix” them.  They want their somatic complaints validated by a concrete diagnosis and a picture on an MRI or X-ray.  It is a tricky road to counsel patients in such a way as to navigate this situation. If they reject you and bolt, it is well within their ability to doctor shop until they get the answer they like, wise or not.

I think my clinical approach is most wise and best for the patient.  However, it is not the approach taken universally by clinicians.

I will occasionally review/witness the work clinicians who are charismatic, aggressive and cock-sure. I have talked to their patients.  The patients love these doctors.  It does not matter that the treatment was not successful, or that symptoms continue.  There is always an explanation of how in their case there was an extenuating circumstance, or scapegoat – “you build tremendous scar tissue”, or “we got to it too late to resolve it but prevented so much potential long term damage!” Never will you hear admission of defeat or failure.

These clinicians will boast their credentials or magnify them past reality.  They will utter things like: “I am the best at this, no one does this technique the way I do.  You are so lucky you came to see me when you did!”

But the patients eat it up and love it.

Is a confident approach useful to patient outcomes?  If a patient feels “helped” or subjectively “better” as a result of your “presentation” then what is the harm?  Is this not an innocent placebo effect?  Does the end justify the means? This is the gray zone where discussion is interesting.

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