Second Opinion: When we attend a doctor, what seems to matter above all is that he have an agreeable face, confident manner and the look of competence. His ability and even his reputation are of secondary importance to a good bed-side manner.
Senior consultants with slicked-back grey hair have taken a bit of a hammering in the media recently, but the doctors we still love to love are of the Norman Rockwell variety - kindly old buffers who put their stethoscope on the child's doll first.
Why does bed-side manner matter? In most other areas of life we do not care a whit for personality. When our car breaks down, we expect to be told dispassionately what's wrong and how long it will take to fix. In our cyber age, the facts of disease are but a few taps of a keyboard away, and many people have acquired a working knowledge of medical matters.
Yet somehow, when it comes to meeting the doctor, the truths about illness have to be shrouded in chummy prevarication.
Recent radio and television programmes have shown bad news has to be softened with euphemism or the doctor is considered callous, and the 'death' and 'cancer' words must be avoided at all costs.
Problems arise when there is deception between two parties, and the difficulties are likely to be compounded with time. The ill and their relatives, going through perhaps the greatest stress of their lives, can have short memories, and when the good doctor's vaguely cheerful but false prognosis is shown to have been a puff of air, it is no good him entering the plea that he was trying to be kind. The patient sees himself as a duped victim.
The burden of carrying falsehoods causes doctors considerable stress, and does no service to patients. Nowhere is this more obvious than when breaking the news of a terminal illness. Anyone has the right not to have to hear bad news, but conspiracies of the sort "we can't tell Dad because he won't be able to take it" deprive that man of perhaps his only opportunity for frank expression before he dies, and they demean the doctor. It might be considered sensitive not to worry or hurt patients but diagnostic "purdah" of this sort has done more to harm confidence in doctors than anything else.
As with all seemingly impregnable authorities, much medical practice has been debunked by recent humiliations, and there is, rightly, no longer blind faith in consultants. There will always be some doctors who are better, more empathetic, than others, but we should stop talking about "top specialists" and "leading surgeons", and appreciate that most doctors, like most people, are just ordinary.
Furthermore, it is not the doctor's exclusive right to know that many diseases just happen and little can be done about them; and that so many western afflictions would be alleviated (if not cured) if we just walked more and drunk less. Patients, relatives and doctors all need to be on the same wavelength, and while no one is suggesting doctors should be rude, bed-side manner doesn't come into it. When a patient comes into hospital now, diagnostic and therapeutic paradigms are followed by a co-operative of teams. Though there are many variations on a theme, most illnesses follow a predictable course, and, for example, one patient with a particular type and grade of cancer behaves very much like another. To deceive, or allow oneself to be deceived about this, is at best a humiliation.
More important than the impact on the individual of this mutual deception, is the effect it has, at the most fundamental level, on the organisation of healthcare. If doctors don't tell, or don't feel free to tell patients the truth about their illness, and if most people continue to prefer denial, how can resources be used to best effect?
Priorities in spending, whether waiting list initiatives or health board reorganisations, are based on false premises and have become merely sticking plasters. The important facts about each common illness could be written on one side of A4 paper, and a service could be done the public by presenting such information in a simple digestible form.
Eavesdrop on any conversation about doctors and the opinions will swing between devotion and disdain - even hatred. It has always interested me to speculate how many of the latter have merely been plain-speaking, kind doctors who lacked the easy patter that passes for concern. The most important quality a person can have is humanity, a simple visceral feeling for another's plight and it is of course reassuring to find it in a doctor. But bed-side manner is altogether different: the very term suggests a style of behaviour which has been adopted rather than something genuine and heartfelt, and in any case it is irrelevant to the profound distresses of human illness and mortality.
The idea of bed-side manner implies an 'us and them' relationship - a distance with roots in dubious traditions, class distinction and simple, numbing habit. It is fundamentally dishonest. Compassion is either there or it isn't, but without professional honesty a doctor does his patients a disservice, will not sustain their respect and ultimately will never do as much for them as he could have. Unfortunately, for all that is said about the poor communication skills of doctors, the general population seem less receptive to professional honesty than ever.
• Steven Young is a consultant neurosurgeon and works in the National Neurosurgical Centre, Beaumont, and the Mater Hospital, Dublin