“Can’t I just fake it? Can’t I pretend to care, even if I don’t.”

So an anonymous physician is reported to have responded during a workshop on caring communication with patients. My colleagues and I all scoffed with appropriate indignation when this story was told, as the same training was presented to us—but I’ve started to wonder if there may not be some backwards wisdom in the statement.

Of course we’d all like our colleagues to be warm and caring individuals, and when we are patients, we want to be cared for by professionals who have genuine warmth and concern for our wellbeing. Nevertheless, no matter how warm and fuzzy we feel and no matter how much we advertise our compassion, the way our caring is communicated is by what we do.

Yes, modern medicine is complex and the daily practice of medicine requires attention to many details and multiple systems. But medicine is not just about the systems, it’s about the patients those systems are designed to serve.

When oversights in communication, overly complex instructions, or obtusely confusing ways of doing things get in the way of giving patients the best possible care, there can be no excuses. “We slipped up” or “we goofed” or “that’s not what I meant those instructions to say” are not euphemisms for “I really do care even though we didn’t get it right.” They are slip-ups, goofs, and bad care.

When I take my auto to the shop for an oil change, I don’t worry (for the most part) whether the mechanic likes me. What I care about is if quality work is done, and whether I get my vehicle back on time. It’s not the feelings, it’s the work that matters. (Side note here—fortunately, I am blessed to have a great guy as service manager where I get my auto work done).

In the same vein, what matters in medicine, is that good medicine is done. This does not just mean smart doctors coming up with brilliant diagnoses. It means thorough attention to getting it right, from the big picture down to the smallest of details.

Can you fake caring? Really, the answer probably is no. If you don’t care, that will come through. But if you think you care and you can’t get the details right or you leave your patient hanging, that also comes through.  Actions, as they say, really do speak louder than words.

If you want a warm fuzzy, get a cup of hot cocoa—if you want to communicate care, be sure your feelings and words are given life in thorough, attentive, competent actions.

Competing interests: “I declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare.”

William E Cayley Jr practises at the Augusta Family Medicine Clinic, teaches at the Eau Claire Family Medicine Residency, and is a professor at the University of Wisconsin, Department of Family Medicine.