Growing Ideal Doctors

Virtually all of my postings on this blog so far have dealt with the challenges to physicians in their relationship with their patients. Remember that it is not only the physician who face challenges but also the patient with their physician. The doctor-patient relationship is ideally a two way relationship and one must not only consider what makes an ideal doctor but also what makes an ideal patient to benefit and support this relationship. However, it is the patient who is ill and who is the recipient of the physician's care and therefore it is primarily the physician who bears the responsibility and burden of attempting to make the relationship work to the patient's benefit.

Last year a visitor to my Bioethics Discussion Pages website wrote the following:

Since I have been a student at a large medical center, I have had the opportunity to interact with many different kinds of doctors from a wide range of specialties. In my opinion, there are several qualities that make up the ideal doctor. First and most important of all, I think that doctors need to be excellent listeners. I'm sure it is very overwhelming to them sometimes because they must listen to patients, family members and all members of the health care team. But, if they can truly listen to what everyone has to say, they can provide even better care because they understand all aspects of the patient. Another quality of the ideal doctor is to be an expert at their field of study. If they don't know something, then who is going to know? I'm not saying that they need to know every tiny detail because that would be impossible, but the ideal doctor should be able to admit when they don't know something, and be able to be resourceful enough to find the right answer for their patient. I think in today's world, many patients have some knowledge of health care and actually do research on what conditions they might have. The ideal doctor can realize this and counsel with the patient so they can discuss all available treatment options. I also believe that the ideal doctor has the qualities of empathy and compassion. Just by having those two qualities, I think that patients sense this and feel more bonded and trusting to their physician.

Doctors have a very important and life changing position, and I feel that the ideal doctor would not abuse this power. The ideal doctor is understanding, competent, and conducts himself after thinking about things ethically. Overall, I am glad to have been able to think about this subject, and I hope that everyone will decide for themselves what makes their "ideal doctor!"

I think that most of us would agree with this visitor's description. Beyond technical knowledge and competence, how does the medical profession grow and develop the compassion, empathy, understanding, ethics and even altruism (all of which is part of professionalism) in their physicians? Actually, the development of a person to later become an ideal doctor begins well before entry into medical school. It is seen in how the person deals with others in his/her social interaction, how stressful and frustrating issues of life are dealt with, what are the individual's views and goals and finally what is the motivation to become a physician. Then comes medical school.

Prior to last few decades, professionalism was really not taught the students in medical school. It was felt that they would learn how to behave by watching and interacting with their colleagues and mentors as they began to treat patients. This approach was, in recent years, felt to be inadequate and so there has been some effort to include teaching professionalism in medical school. Unfortunately, explicit teaching of compassion, empathy and ethics and more that makes a physician not just a technician but the ideal doctor described above has not really been continued as the student goes into his/her clerkship, internship and residency years. In fact, what the student learned in the earlier years of medical school tends to be deminished and altered by the stress and pressure of increasing patient responsibility and trying, out of self-interest, to follow the leads of their superiors regardless of what behavior their superiors demonstrate . Unfortunately, their superiors may not represent the behavior of the ideal physician and their tacit teaching may be deconstructive rather than supportive of the student's earlier teaching. Fortunately some students seem to be "immune" to these influences and demonstrate the features of the ideal doctor. Others go on to be simply technicians or doctors who practice a disregard for the emotions or values of their patients and maintain "doctor knows best" attitude.

What is need for the growing of the ideal doctor is not only a good seed but also a nourishing soil, most likely in the form of mentors, during the developing years, who themselves demonstrate the best of professionalism and who are themselves ideal doctors.

To read more on this topic: Coulehan and Williams, "Conflicting Professional Values in Medical Education", Cambridge Quarterly of Healthcare Ethics, v.12, p.7-20, 2003.
..Maurice.