The Soft Skills Doctors Can’t Afford to Lose

Medicine has always balanced art and science, but some say modern forces are chipping away at the art. Today’s physicians practice amid an expanding stack of technology — from AI scribes to predictive analytics — and within corporate systems where most no longer call the shots. Meanwhile, patients’ expectations and cultural norms are shifting, too. But some of the most essential skills in medicine aren’t technical. They’re the “soft skills,” such as communication, humility, and adaptability, that many physicians worry are being squeezed out — undervalued in training, overshadowed by technology, and eroded by system pressures. Medscape Medical News asked six seasoned physicians to share the soft skills they’ve learned over decades of practice, what’s slipping, and why it matters. Knowing Where Your Patients Come From Early in his surgical career, Douglas P. Slakey, MD, had a liver transplant patient who arrived at appointments impeccably dressed and surrounded by supportive family. She developed recurrent infections he couldn’t explain — until he drove past her home and saw a dilapidated house on the edge of a bayou, where moist conditions can promote bacterial growth. “Once I saw that, and that was really a pivotal moment, I said that we need to understand much more about the reality our patients are facing,” said Slakey, HCA Healthcare Health Systems Science Endowed Chair at Belmont University in Nashville, Tennessee. After her housing conditions improved, her infections resolved. Experiences like that highlight how the context of health — social determinants, geography, family, spirituality, and environment — can dramatically influence outcomes. “Health is so much more than what we do in the four walls of our hospitals or operating rooms or clinics,” he said. “We’ve focused so heavily on the molecular and physiologic basis of disease that I think we’ve sometimes neglected to teach our healthcare providers about these other aspects of health.” Avoiding the Temptation to Rush the Conversation When giving a nonurgent diagnosis, resist the impulse to launch into planning mode and instead give patients space to absorb the news. “One of the problems eroding skills is you barely have time to talk to a patient,” said Kathleen Wyne, MD, PhD, an endocrinologist at The Ohio State University Wexner Medical Center in Columbus, Ohio. That time pressure pushes clinicians to move too fast, overwhelming patients. “We try to do too many things, move too fast, and do not hear that the patient is not ready to move forward or is fearful to make changes.” She sees this often with Graves disease. “We were taught to immediately speak to the person about definitive therapy and give them all their options,” she said. But there’s no need to detail invasive treatments, such as surgery or radioactive iodine, on day 1. Many patients are young, frightened, and not ready to decide. “The patient needs time to get accustomed to having this disease process, to understand that it’s not their fault, that they need medicine to get it under control. Then, once it’s under control, we can talk about long-term options.” Listen closely to patients when you introduce a topic. “That first couple sentences is really telling you why they’re here, what they’re interested in, what they’re not interested in, and what they’re willing to do,” Wyne said. End visits by asking what the patient needs now — Wyne’s go-to: “What can I do to help you at this time?” Giving Patient Answers to Patient Questions When patients raise doubts about vaccines, respond calmly, avoid arguments, and offer clear, compassionate information. “Increasingly, particularly among my pediatric and family practice colleagues, young parents are asking more and more questions about vaccines,” said William Schaffner, MD, professor of preventive medicine at Vanderbilt University Medical Center in Nashville. “Even we internists, as we try to promote influenza and COVID and RSV [respiratory syncytial virus] vaccines, among others, we’re getting more questions.” Schaffner begins by reassuring patients that their concerns are normal, then briefly reviews the vaccine’s benefits and notes that he and his family — including his children and grandchildren — are vaccinated. “Don’t get into an argument or challenge the patient or express surprise or incredulity,” he said. If a patient declines, he accepts their decision for the moment and plans to revisit the topic later. Schaffner often tells his students about one older patient who reluctantly took the flu vaccine and later complained of a mild illness. “When I saw him again in the spring, he grumbled to me because he had gotten the influenza, even though he didn’t need hospitalization and recovered after a few days,” Schaffner said. “As I stood there and listened to him, I just smiled very broadly, and I said to him, ‘I am so glad you’re here to complain.’” The patient and his wife laughed — and got their flu shots the next year. Bearing Witness to the Hard Moments Clinicians should not look away when patients die; engaging with grieving families is part of care. Ezekiel J. Emanuel, MD, PhD, vice provost for global initiatives at the University of Pennsylvania in Philadelphia, vividly remembers his first panel of about 40 oncology patients — many of whom were expected to die. He had no guide for handling end-of-life conversations, such as informing and comforting the family or talking about organ donation. “I realized, as I was having more patients die, that just walking away and doing the next thing when the family was grieving was a mistake,” he said. Emanuel began a practice he now widely recommends: writing and mailing notes to families after a patient dies, describing admirable qualities, sharing a fond memory, or passing along a meaningful story the patient told him. “Every person has good in them, and you’ve got to talk about that with the family,” he said. Traditional curricula focus on smarts and technical talent, but emotional intelligence matters: “The ability to learn empathy and to understand its importance in medicine is somewhat underrated,” Emanuel said. Research shows that empathy can be taught through instruction, practice, reflection, observation, and feedback. Committing to Mastery Larry I. Lipshultz, MD, professor of urology at Baylor College of Medicine in Houston, got the best advice of his career when an established physician told him: Find a tall tree and climb it. In other words:Pick an area and work to become the best at it — opportunity often comes from focusing and practicing one niche. What that meant for Lipshultz was vasectomy reversals: At the time, only a few surgeons offered the procedure as demand rose, so he dug through textbooks, practiced sewing under magnification, refined microsurgery techniques, taught others, and launched a fellowship program. Today’s physicians have resources he couldn’t have imagined — social media, AI tools, and industry-sponsored education — so he encourages early-career physicians to soak up knowledge and pay attention to patients’ unmet needs. “I don’t think younger people today realize how fortunate they are to be in this field, how lucky they are to meet all these patients that you meet, with these heartbreaking stories, that you can actually help,” Lipshultz said. Embracing Human Judgment in the Age of AI Physicians must retain core clinical judgment even as AI tools become more helpful in practice. “I have come to the conclusion that until AI completely takes over my job — which I think will be a long time from now — it still is going to be very important that I understand the foundational language of medicine,” said Robert Wachter, MD, professor of medicine at the University of California, San Francisco, and author of A Giant Leap: How AI is Transforming Healthcare and What That Means for Our Future. Even with powerful tools, clinicians need to know which patient details to enter and how to interpret the results. Wachter noted AI is especially helpful in coaching difficult conversations: He sometimes asks it how to approach a family requesting aggressive care he believes isn’t appropriate and how to counsel them. “For a new medical student or an intern to be able to use AI to coach them through a challenging situation, I’ve found that to be quite useful,” he said. The risk is overreliance. “It’s one thing for me to use the tools after being practiced for 40 years, and I probably will de-skill a little bit, but it’s against the background of a lot of skills and experience,” he said. “But I think there’s a difference between de-skilling and never-skilling.”