What are the qualities that every good doctor must have? Compassion Compassion is the "ability to identify with the suffering of another or to imagine ourselves in a similar state," wrote John Saunders, MD, MA, past chair, Committee for Ethical Issues in Medicine, Royal College of Physicians, London, UK. Exercising compassion "is an essential component of good medical care in many situations and requires grounding in moral principles," Dr. Saunders stated, acknowledging that some people are innately disposed to be compassionate while others aren't. But those who aren't instinctively compassionate shouldn't throw in the towel. "Although our dispositions vary, compassion is a quality that can be developed in all of us." Understanding What is understanding? It's not merely knowledge or comprehension. "In a phrase, understanding is the ability to think and act with what one knows," wrote education expert David Perkins, PhD, in the book Teaching for Understanding: Linking Research with Practice. "In keeping with this, learning for understanding is like learning a flexible performance—more like learning to improvise jazz or hold a good conversation…than learning the multiplication table," Dr. Perkins wrote. "Learning facts can be a crucial backdrop to learning for understanding, but learning facts is not learning for understanding." What does this mean for you and your patients? You want your patients to understand your recommendations, understand how and when to take a medicine, as well as its benefits and side effects, or understand what's involved in a certain procedure and its potential outcomes. In other words, you want your patients to not only have the knowledge, but to be able to act and make decisions based on that knowledge. Now switch places with your patient. They want you to appreciate their knowledge, and to be able to act on it accordingly. When you think about it that way, how well do you truly understand what your patient is trying to tell you? Empathy Empathic nonverbal cues vs unempathic ones. (Photo: Kraft-Todd GT, et al; CC BY 4.0) In simple terms, empathy comes across as warmth. In more scholarly terms, empathy is "a social-emotional ability having two distinct components: one affective: the ability to share the emotions of others, and one cognitive: the ability to understand the emotions of others," according to authors of a recent paper on the subject. In other words, empathy is an emotional identification of both heart and mind. There's some thought that patients may believe that doctors who show warmth are less knowledgeable or less competent, and thus these doctors face a trade-off between being perceived as competent or as empathetic. But the authors found just the opposite in their study. Doctors who displayed empathic nonverbal behavior—such as eye contact, smiling, and uncrossed arms—were perceived as both warmer and more competent. "Our findings might reflect a changing concept of the role of doctors in our society. No longer are they judged solely on their technical competence—that is, their ability to perform medical procedures. Rather they may increasingly be judged on their interpersonal competence—that is, their ability to navigate the difficult social interactions inherent in managing patients' illness and wellness," wrote study author Gordon T. Kraft-Todd in a Scientific American blog. Honesty Being honest with patients should be straightforward—just part of the routine. It's right there in the American Medical Association's Code of Medical Ethics. Unfortunately, modern medicine can lead physicians into gray areas, in which the most helpful thing to say might not be the most truthful thing. In fact, one-fifth of physicians said that fudging the truth is not necessarily out of bounds, according to a 2012 nationwide survey of nearly 1,900 practicing physicians. More than 1 in 10 admitted they had told patients something untrue within the previous year. "Some physicians might not tell patients the full truth, to avoid upsetting them or causing them to lose hope," the survey authors wrote. However, "studies of communication with gravely ill patients show that patients prefer honest and accurate information, delivered with empathy and understanding by clinicians, even when prognoses are dire." In short, honesty is still usually the best policy when communicating with patients, especially if you convey it with genuine care and concern. Competence "Most American physicians meet a basic threshold of competence—our system of licensure, board exams, etc. ensures that a vast majority of physicians have at least a basic level of knowledge. What most people don't appreciate, however, is that even among this group, there are large, meaningful variations in capability and clinical judgment," wrote Ashish Jha, MD, MPH, Harvard School of Public Health, Cambridge, MA. "In measuring doctor quality, we might focus on 'soft' skills like empathy, which we can measure through patient experience surveys," Dr. Jha wrote. "But we also have to focus on intellectual skills, such as [the] ability to make difficult diagnoses and emotional intelligence, such as the ability to collaborate and effectively lead teams—and we don't really measure these things at all, erroneously assuming that all clinicians have them." Caring is essential to be a good doctor, Dr. Jha indicated, but providing good care means keeping abreast of the best care to provide. Commitment You're probably a physician who's committed to your profession, to your patients, and to continued self-improvement. That's good news because doctors who are committed—who feel that the profession of medicine is not just a job but a calling—may be less likely to experience burnout. "Commitment as a personal resource protects individuals from the negative effects of stress because it enables them to attach direction and meaning to their work. Without such commitment, a valuable source of protection from stress and its consequences would not be available," according to psychologists who study these issues. "Commitment is therefore a crucial resource that enables individuals to resist the effects of stress and strain in their organizational environments." The authors discussed the concept of distancing, a defensive strategy in which physicians suffering stress begin to depersonalize their interactions with patients and turn sour against their workplace and the profession itself. When physicians feel they don't have the resources to cope with stressors (ie, they don't feel committed), then distancing sets in, and they start to consider if it's time to quit. On the other hand, having resources to cope with stressors may overcome this need for distancing while preserving feelings of commitment. In short, if you're feeling distancing coming on, get some help and you may be able to restore your sense of calling. Humanity Sir William Osler said, "The good physician treats the disease; the great physician treats the patient who has the disease." Surely, some mentor in medical school told you much the same thing: "Treat the patient, not the disease." One of the conclusions in The BMJ survey cited at the beginning of this article: "To be a good doctor, you first have to be a good human being: 'a good spouse, a good colleague, a good customer at the supermarket, a good driver on the road.'" Also, the authors noted, it's easier to be a good doctor if you like people and genuinely want to help them. One respondent wrote: "To like other people, from this all else follows. Liking your patients will get you through the grind and tedium of your working day, and patient contact will be a source of strength and renewal. You may even do some good." Courage Nelson Mandela said, "I learned that courage was not the absence of fear, but the triumph over it." The term frequently used in medicine is moral courage. "Moral courage can be defined as the voluntary willingness to stand up for and act on one's ethical beliefs despite barriers that may inhibit the ability to proceed toward right action. Such courage is critical to physicians' commitment to act in the best interest of patients," wrote authors in an article about measuring moral courage. "Physicians commonly face situations that call for moral courage, including delivering care to an infectious patient, meeting an angry patient or family member, addressing an incompetent or impaired colleague, disclosing a medical error, and raising concerns about unethical or unsafe practices," the authors wrote. Don't be discouraged if you can't always meet these high expectations. Remember that courage isn't always the act of trying to do what is right, but sometimes just the act of trying again. Respect Do you give your patients the respect they deserve? "Patients are generally aware of how much their physician respects them. Physicians who have respect for particular patients provide more information and have a more positive affect in visits with those patients," according to a study by researchers at Johns Hopkins University School of Medicine. Physicians reported higher levels of respect for older patients and for patients they knew well, researchers found. However, "the level of respect that physicians reported for individual patients was not significantly associated with that patient's gender, race, education, or health status," they observed. The researchers recommended that physicians remain aware of how their feelings might impact their behavior as perceived by patients. "It might be tempting for physicians to think that their behaviors are not influenced by how they view or feel about patients. Our results suggest that ignoring this association may negatively impact patients," the study authors wrote. On the flip side, what about patients' respect for physicians? "MDs no longer get the same respect as we used to," said an internist in an MDLinx survey earlier this year. Still, 76% of respondents reported being very or somewhat satisfied with the social status of physicians in the United States. "At least we are more respected than lawyers," quipped a pediatrician. Optimism Do you inspire your patients with optimism? Generally speaking, patients who are more optimistic tend to have better health outcomes. Optimism has been linked with a range of physical health benefits, from reduced risk for cardiovascular disease and stroke to healthier levels of antioxidants and lipids. Optimism is also associated with healthier behaviors—optimists are more likely to exercise, eat more healthily, manage stress better, and abstain from smoking. Fortunately, optimism can be learned and shaped by social influences, to some extent. Patients who have an optimistic spouse, for example, tend to have better health than patients who don't. If nothing else, most patients would prefer a bad diagnosis to be delivered with at least a hint of hope. One meta-analysis concluded that the majority of patients with terminal illnesses and their caregivers want physicians to be honest when discussing prognosis and end-of-life issues. "However, there are different views of what constitutes an honest approach, with some desiring a straightforward or direct approach, others desiring accurate information but without bluntness or too much hard, factual, or detailed information, and still others desiring a combination of honesty and optimism," the authors wrote. Many patients and caregivers identified this combination of honesty with sensitivity and empathy as "hope giving." So, those are the 10 qualities you need to be a good doctor. But, they're just the tip of the iceberg. A good doctor is also one who is attentive, analytical, brave, calm, cooperative, creative, decisive, energetic, ethical, friendly, gracious, humorous, investigative, knowledgeable, mature, nurturing, observant, passionate, responsible, reassuring, selfless, skillful, trustworthy, vigilant, and wise. Feeling overwhelmed? Don't be. Remember, these criteria were suggested by your fellow physicians. What do patients want of you? Patients want little more than a doctor who listens to them, according to The BMJ survey. So if you do nothing else, do that. Listen. Source
