Bioethics Discussion Blog: Growing Ideal Doctors

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Friday, July 30, 2004

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.

2 Comments:

At Friday, January 27, 2006 6:44:00 AM, Anonymous Moof said...

[...] 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. [...]"
emphasis mine

Dr. Bernstein, I agree with your entire post, however, the above point leaves me a bit puzzled. How does one teach compassion or empathy?

I think that good physicians are born that way ... there are plenty of good physicians who are not also medical doctors - they may be pastors, rabbis, counselors ... or shoe salesmen. Whatever it is they do isn't as important as what they are.

In my mind, a good physician follows his heart into medical school, and not simply his intellect ... and once there, learns the balance he needs to also be a medical doctor.

I don't believe that any amount of schooling is going to teach empathy to a person who was not born with it. It may teach him to become aware of another human being's pain, but empathy is more than an intellectual awareness - it's a human dimension that some people simply do not have.

A bit over a year ago, I had to see a specialist at a major hospital a few states away. This fellow was going to perform some surgery for me at the behest of one of my own physicians. Apparently, he appears in all sorts of journals and publications, was chosen by some prestigious group as one of the nation's best in his field, and is well known across the country. On my first visit, his nurse bragged about how busy he was, and how many patients he had. My own assessment as a patient? He is a joker and quipper ... does not "connect" with his patients ... and seems as if he goes through life on "automatic" ... barely tuning in to what he's saying and doing. As a physician, I trusted him explicity because of his credentials, and the assurances of my own physician ... however I would never have sought him out myself, and I most probably will not do so in the future.

To be fair, he may have started out with empathy ... and lost it along the way to too many pressures and demands, however by the time I met him, he had what I think of as "acquired compassion." The actions are there - but the shell is empty. I would far prefer a physican who "connects" with his patients, even (and perhaps especially) if he hasn't climbed to the top of his field ...

.

 
At Friday, January 27, 2006 11:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Moof, I probably should have written "explicit teaching of the process of developing compassion, empathy and ethics..." because that is what I meant. Of course, students enter medical school with a varying degree of ability to provide compassion and empathy to their future patients. Much of the variablity has to do with their prior life experiences but also I am sure something intrinsic to them as human beings. But we can teach the process and that is not simply acting. We don't want students or doctors to act compassionate or empathetic, we want them to be compassionate and empathetic. But to show and behave to patients these qualities requires education first about their importance in the relationship to and therapy of the ill patient. They must also learn that such expression, if it is to be true and meaningful, is going to be different with each patient. Their needs for how the compassion is best expressed will be different in each patient. Also, since empathy, to be true, means that the student or doctor should first be aware of the burden that the patient is bearing and then look into themselves for the student or doctor's own personal or family similar burdens so that they can say to the patient "I think I know how you are feeling.." and mean it! What I have just written is part of what needs to be taught.. it is the process. The unfortunate part is that particularly those who entered medical school weak in the ability to develop compassion, empathy and ethics (and I guess admission committees can't easily weed them out), they may thoroughly lose what we taught them in the first and second years when they move on to the later years in school and later in internship and residency because of poor mentors in those years.

Moof, thanks for catching my misspeak so that I could explain better what I meant. ..Maurice.

 

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