Bioethics Discussion Blog: The Meticulous Doctor: An Ideal Doctor?

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Thursday, May 18, 2006

The Meticulous Doctor: An Ideal Doctor?

From the “THE BOSCOMBE VALLEY MYSTERY” in the classic "The Adventures of Sherlock Holmes" by Arthur Conan Doyle, Sherlock Holmes. after inspecting the grounds of where a murder had taken place responds to his friend and colleague Dr. Watson’s questions:

…"And the murderer?"


"Is a tall man, left-handed, limps with the right leg, wears
thick-soled shooting-boots and a gray cloak, smokes Indian
cigars, uses a cigar-holder, and carries a blunt pen-knife in his
pocket.

By an examination of the
ground I gained the trifling details which I gave to that
imbecile Lestrade, as to the personality of the criminal."

"But how did you gain them?"

"You know my method. It is founded upon the observation of
trifles."

"His height I know that you might roughly judge from the length
of his stride. His boots, too, might be told from their traces."

"Yes, they were peculiar boots."

"But his lameness?"

"The impression of his right foot was always less distinct than
his left. He put less weight upon it. Why? Because he limped--he
was lame."

"But his left-handedness."

"You were yourself struck by the nature of the injury as recorded
by the surgeon at the inquest. The blow was struck from
immediately behind, and yet was upon the left side. Now, how can
that be unless it were by a left-handed man? He had stood behind
that tree during the interview between the father and son. He had
even smoked there. I found the ash of a cigar, which my special
knowledge of tobacco ashes enables me to pronounce as an Indian
cigar. I have, as you know, devoted some attention to this, and
written a little monograph on the ashes of 140 different
varieties of pipe, cigar, and cigarette tobacco. Having found the
ash, I then looked round and discovered the stump among the moss
where he had tossed it. It was an Indian cigar, of the variety
which are rolled in Rotterdam."

"And the cigar-holder?"

"I could see that the end had not been in his mouth. Therefore he
used a holder. The tip had been cut off, not bitten off, but the
cut was not a clean one, so I deduced a blunt pen-knife."



Is this example of meticulous inspection and interpretation what you would be satisfied from your personal physician or is there something else or more that you would expect?

On the blog posting from July 2004 about “Growing Ideal Doctors”, I had started the discussion of ideal doctors. I would like to continue the discussion by presenting my visitor comments to the question from the now inactive “Bioethics Discussion Pages” on that very subject. The oldest comments start at the bottom of the post. ..Maurice.


What Makes an Ideal Doctor?

Many of the topics throughout these pages represent issues of medical care and how physicians ought to provide care to the sick. It is important that the public have a voice in these issues. Beyond these issues, it would be also valuable to hear what the public considers are the characteristics which make up an ideal physician. What is it about a doctor which would make you feel the most comfortable and give you the greatest confidence with regard to you or your family's care?

Here are the questions:
What do you think are characteristics which make an ideal doctor? What are those which would cause you to reject a physician?

Date: Fri, May 9, 2003 12:22 PM From: Linda.Spore@BTLaw.com To: DoktorMo@aol.com

The "ideal" doctor is someone who validates my pain, listens to my problem and treats me with professional courtesy. I, in turn, want to be the ideal patient. Who asks questions, follows medical advice and says "thank you." I have found that doctors are not what they used to be; it used to be about the patient, now it's about them and making money.
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Date: Tue, Apr 1, 2003 4:07 PM From: CPerisee@aol.com To: DoktorMo@aol.com

As a nurse and nursing student, I have seen what I would say are "ideal" physicians and some you look at and wonder why they are even in the profession. What I consider to be a good characteristic of an ideal doctor is a doctor who treats patients and all in the health profession as human beings. In the profession, everyone is there to work as a team. Sometimes doctors do not view the care of the patient in this matter. I know that the profession is becoming stressful due to the shortage, but we must be there for our patients and one another.
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Date: Mon, Mar 3, 2003 9:24 AM From: etornholm@kumc.edu To: DoktorMo@aol.com

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!"
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Date: Mon, Oct 28, 2002 3:19 AM From: corka.hill@bigpond.com To: DoktorMo@aol.com

[ Moderator's Note: This visitor writes views on a number of ethical issues but concludes regarding the ideal doctor]

I am answering more than this one question but I think that a lot of them are intertwined. Although we do not live in the time of the ancient Egyptians and I do not believe that we need our organs for the next life I do believe that we should all have the choice to donate or not. In death as in life we should be able to make decisions about our own bodies and those decisions should be respected in the same way that someone's request to not be resuscitated should be respected and the same as a patients choices for their care should also be respected. No-one has the right to decide for someone else if they are still capable and even when they're not I find it hard to let people make choices for others. I believe that a terminal patient should be able to refuse treatment, I believe people should be able to refuse treatment on religious grounds. I do not believe that parents should be able to refuse life saving treatments for their children. Such children should be given the chance to grow and live and make their own decisions. I do not believe in 'social worth'. It disgusts me that a lot of healthcare is available according to a persons financial situation. This leads me to what makes the perfect doctor. I knew a doctor once who bulk billed all his patients through Medicare including ticking the bulk billing box when sending patients for x-rays and bloods so that they can save on gap fees. He also provided his home number, pager number and mobile phone number to his patients. They were all actually printed on his card. He treated the patient but he also treated the family and the marriage. He always made sure he new the full story and was never in too much of a hurry. I have never seen him make a decision lightly. I have also never seen him dismiss a patients fears or beliefs. He was one of those doctors who would lend an ear as often as he would treat a complaint. That is the perfect doctor. I only wish we still lived there. Thankyou, K.Hill, Brisbane, QLD. Australia

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Date: Sun, Oct 20, 2002 9:21 PM From: slwilliams06@msn.com To: DoktorMo@aol.com

My experience with a local physician one time was a perfect example of what I would not want in a doctor. I found this man to be rude, inconsiderate and quickly hurrying through a visit that I was really worried at the time. I actually was having an allergic reaction to medication and I feel he never believed me. During a doctor visit after this incident a week later, I preceded to tell him that I did not appreciate the way he treated me. He made me feel like I was imagining symptoms and he could understand why I was feeling so bad. I looked perfectly normal on the outside. I found myself telling this physician how rude he was and continued telling him that I felt he never heard a word of what I had said to him when since he had met me. So, the ideal doctor would be someone who takes the time for their patient to listen and be concerned when someone is scared. The doctor entered into the field to help people and he should never forget that thought process. He should have respect for all his clients and always bring himself down to the patient's level as a person.

Shelly Williams, OUSN
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Date: Tue, Oct 8, 2002 5:04 AM From: winstonjen@yahoo.com To: DoktorMo@aol.com

I believe that it's quite simple. Since no one is more directly affected by the doctor's actions than the patient, doctors should serve their patients first and foremost, respecting their wishes. Treatment without consent is assault. Few things are worse than doctors who preserve life at the cost of comfort and wellbeing. The last thing a patient needs is a doctor who cares more about being 'morally correct' than about what the patient wants.

Sincerely, Winston
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Date: Mon, Jan 7, 2002 5:49 PM From: debbiesdoodles@mindspring.com To: DoktorMo@aol.com

I know the answer to this one, having learned it the hard way. The ideal doctor is an expert in medicine who presents options for health to the patient and lets the patient decide the path they will take together. His ego is small, his purpose is to offer counsel. He has enough faith in his patient to allow her to make her own decisions and he supports her cause and her choices.

When I finally found this doctor, my decade-long battle with life-threatening disease was won. Although I will never again be of complete health, I am once again a contributing member of my family and of society in general.

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Date: Wed, Dec 26, 2001 8:09 AM From: diabolicmaniac@yahoo.com To: DoktorMo@aol.com

An ideal physician is an altruist. He/she must never put personal gain before the welfare of the patient. He/she must also be able to feel empathy for every patient that is encountered and must never look on patients as second to the physician. The physician must never ever have any notions of prejudice towards patients, let it be by race, colour or any other attribute of patients. He/she must also have an unbreakeble will to help others to get as well as possible.
Date: Tue, Oct 2, 2001 8:55 PM From: efresne@kootenay.com To: DoktorMo@aol.com

Speaking as someone who has been injured in a doctors care and will be affected for the rest of my life, which will be from this point on riddled with interventions. There are a few things I will forever look for and walk if they are not present. 1)honesty 2)they must truly and sincerely want to help. 3)I must feel that I or my Family is more than a $ to them. What it comes down to is trust. And now if I can, I will reach as many people with my story and they will reevaluate their doctors, causing a change for the better in the level of care we receive. Who am I to say this and bring about this change? I will say Someone who will do it!
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Date: Thu, Apr 12, 2001 9:31 PM From: wilson5@rtccom.net To: DoktorMo@aol.com

I am a nurse who has recently discovered an ideal doctor. The one in particular I am referring about is a pediatrician. We live in a small communty where the hospital has not had a good name for a long time. Most people travel to surrounding cities to doctor there. This doctor who I have recently employed is amazing. I has morals. I mean like patient first. NOT money. He is not afraid to speak the truth. Other doctors around here are in a click. THey are mad at my doctor because he transfers patient if they complain about the staff or if he feels they are not equipped to take care of a particular case. Trust me. Its bad on the floor, I worked it before. They (the other doctors do and will compromise their patients health and well being just so the hospital won't get upset. He goes to his patients sports games and stuff if they ask him. He is truely a unique and caring man. He also is a very teaching and nice doctor to work for. He has taught me so much, more than any nursing school could ever teach me. That is an ideal doctor. From Davida

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Date: Mon, Apr 2, 2001 10:51 AM From: mhwallace@yahoo.com To: DoktorMo@aol.com

Thanks for your website. This is a hot topic for me because of a recent broken leg. What the best doctors give me: Sufficient Time

Human Respect

Medical Expertise

Honest Communication

SUFFICIENT TIME: I can get an appointment when I need it. Even if the doctor feels time pressure, I should not be penalized by his overly-full schedule. He should not impose his time pressure on me unduly. I donÕt want to waste his time, but I need him to give me enough to address my concerns and questions. HUMAN RESPECT: I donÕt want another parent figure; I need a partner in health care and treatment and in making the most of my quality of life (QOL). The best doctor helps me understand whatÕs happening to me and what it means to QOL. After all, weÕre talking about MY body. ItÕs not just an arm or leg, itÕs ME, and my future ability to enjoy life and function normally. ItÕs IMPORTANT to me, I need to feel itÕs important to my doc too. I am smart and educated. I want to know and am capable of understanding, and acting on, what's happening to my body and what I can do to affect it. The best doctor respects my time too; if the doctor always runs late; he should review the officeÕs scheduling practices and change them, even if it means increasing billing rates. Another part of respect (and time) is understanding that I only call him when IÕm seriously worried, not just for chit-chat. The best doctors know that, and even if my concern is about something Òto be expectedÓ, he tells me that factually. The best docs have handouts so I can re-read them and make an informed decision about if/when to call the doc, when something happens. MEDICAL EXPERTISE: As in all other areas of my life (financial planner, lawyer), I need to consult my doctor as an expert in an area where I do not have the requried knowledge to do it for myself; I need and expect thoroughly professional, balanced, complete, and dispassionate responses, for a price to be sure, but I'm willing to pay that price for expert advice and detailed information that I can use to drive life-altering decisions. NOTE: I'd be happy to pay for extra time and additional treatment options, even if the insurance company wouldn't -- I just want to know more and be able to participate fully in all aspects of my recovery. Things move so fast today that no one person (or doc) can expect to know everything. I expect my doctor to say when he doesnÕt know something, and to tell me if I or he should learn more about it. After a life altering experience (heart attack, stroke, chronic diagnonsis, trauma), IÕm totally obsessed with my medical situation and healing; after all, I may be at home all day, sitting on my butt with nothing else to do. I'm afraid, I hurt, and when something asociated with my condition feels or looks different, this generates lots of worry & questions. IÕve never had this before, so I have no clue about whatÕs normal and whatÕs not. In the entire world, only this doc knows the details of my injury and treatment because he put me back together. No one other than the doc has any info that I can trust, unless he points me to another resource. HONEST COMMUNICATION: HippocratesÕ directive: ÒFirst, do no harmÓ extends beyond the obligation to provide appropriate medical treatment. It extends to communication responsibility Ð clear, honest, complete, detailed. If asked Òif you were in this situation, what would you do?Ó the patient is trying to access expertise that they donÕt have, and to answer questions they donÕt even know they need to ask. An honest answer shoud be given to the question, along with an explanation and perhaps exploration of WHY. The doc speaks a foreign language (medical jargon); what is routine to the doc is often new to me. I need to doc to speak english, not medicalese. The other side of communication is listening. Docs need to listen to the intent beyond the questions and not get caught in the technicalities of the content/wording. I need my doc to walk in my moccasins for a bit. Docs have personalities, and so do patients. The best docs know that, and adjust communication accordingly.
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Date: Tue, Mar 13, 2001 11:44 AM From: Mkh42@aol.com To: DoktorMo@aol.com

What do you think are characteristics which make an ideal doctor? What are those which would cause you to reject a physician?: A good Doctor sees me as a human being.
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Date: Mon, Jan 29, 2001 10:56 AM From: publicpc@library.ucla.edu To: DoktorMo@aol.com

I'm a premed student who had the best role model in Dr. Jose, an OB/GYN I used to volunteer for. The first thing that's apparent about Dr. Jose is his intelligence. He knew so much about the female body. But even more special about his knowledge was his astuteness regarding the female patient. He understood they had special needs and special pains, and although he'd never actually experiences such personal pains as cramps or delivery, he had so much understanding. I often wondered from where his amazing source of empathy and compassion stems from. He was also very professional. Integrity and ethics was what he always stressed to me. "It's the foundation of practicing good medicine, " he used to say. I aspire to one day have such qualities as competence, human understanding, and strong medical ethics.
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Date: Tue, Mar 21, 2000 10:37 PM From: cinefacta@hotmail.com To: DoktorMo@aol.com

Classically, an ideal doctor (by Hippocratic standards, at any rate), would be one who adhered to the tenets of the Hippocratic Oath: not abusing the power of the position or taking advantage of his patients, not administering abortions or assisting in euthanasia, maintaining utmost confidientality with regards to his patient. Though certain terms and phrases lend themselves to varied interpretations, the overall message and description of how a doctor should conduct himself and his practice are very easy to follow: honor, integrity, and the best interests of the patient. In today's medical world, however, things are not quite so simple, and the Hippocratic Oath of the classical world is not so easy to follow. Some of the provisions of the Oath, such as not abusing the position of a doctor's power, or breaching patient confidientality are still quite valid points, and are standards to measure our own doctors against. However, varied political, religious and moral stances all but render the lines prohibiting abortions and euthanasia useless, though they do serve to set a standard of appreciation and value of human life, and this is a necessity in physicians. To close: an ideal doctor in today's world would be one who set the needs of the patient foremost in his practice and preserved the spirit of the Hippocratic Oath, that is the respect for human life (whether is to respect life by seeing something as euthansaia as a peaceful end to pain, or to respect life by refusing to end it, no matter how desperate it may be) and the perserving the rights of the patient. An ideal doctor would be one who could adapt the Hippocratic Oath to today's world, whether it be applying the basic spirit of the Oath in interpretaion to his practice, or applying it literally.

Michael Stafford,University of South Carolina

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Date: Sun, Mar 12, 2000 9:04 PM From: Bbusbee24@aol.com To: DoktorMo@aol.com

The classical ideal doctor is very simple to describe. One was to be as knowledgeable as that time permitted, always work for the preservation of life, and keep the knowledge esoteric in nature, for a little bit of knowledge can be a harmful thing. The Hippocratic Oath lays all these points forward for one to swear by. It is a clear cut template that all doctors should abide by, the covenant identifies acceptable practices and the ethical code, which is prone to ambiguous interpretation, yet with a common theme of serving the patients best interest. All these characteristics apply to todayÕs ideal doctor, along with a few extras. TodayÕs doctor must be somewhat of a more complex character. The esoteric knowledge has been replaced somewhat by schools and universities that offer teaching to anyone capable. Also, the term ÒdoctorÓ holds so much esteem that it is often difficult to communicate with one. If a patient is too intimidated by a doctor to divulge all the information, no matter how skilled the doctor is, their efforts will fall short. The ideal doctor is one that is capable of performing the task at hand, as well as one who is able to be looked on as a peer.

Brantley D. Busbee

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Date: Sun, Mar 12, 2000 8:01 PM From: dongrant3@hotmail.com To: DoktorMo@aol.com

There are many characteristics of what I would assume the ideal doctor to be found in the Hippocratic Oath, although I may not agree with it in entirety. I feel that a doctor should be very caring and truly love helping people. This love of his profession should come from his desire to help those in need. A doctor should be unselfish and do everything in his power to aid a patient in recovery. I disagree with the Hippocratic Oath in the statement that surgery should not be performed because many times this is the best means by which a person may be aided. One of the most important qualities of the ideal doctor is trustworthiness. This is also included in the Hippocratic Oath. A patient should always feel confident in the fact that his doctor will keep his health issues as well as his personal issues private. He should also trust that his doctor will do everything he can to work in his best interest.
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Date: Sun, Mar 12, 2000 6:51 PM From: Jdtaylor20@aol.com To: DoktorMo@aol.com

In the ideal doctor, I see several necessary characteristics that he or she must possess or somehow obtain. First and foremost, the ideal physician must have an unwavering desire to help those in need. Medicine is, in many areas of society today, a very distinguished and financially rewarding profession. Yet, an ideal physician should not be concerned with making excessive amounts of money. In the Hippocratic Oath, the physician is described as one who performs services "without fee and covenant." Another key characteristic I see in the ideal doctor is a vast knowledge of the "art" of medicine, as it is described in the Oath, especially the particular field in which he or she specializes. Finally, the ideal physician, I believe, must be willing to apply this knowledge through research, to find better methods for patient treatment. I see research and the technological advancements that result from it as being as instrumental in medicine as the actual treatment.

-Jon Taylor, University of South Carolina

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Date: Sun, Mar 12, 2000 5:43 PM From: MayDay913@aol.com To: DoktorMo@aol.com

The phrase "ideal doctor" incorporates many different duties, responsibilities, and meanings. Concern for the patient and the health of mankind in general is a foremost issue. However, the most often expressed trait that doctors need to possess is compassion. They need true, genuine interest in each individual case they work on, making sure that the patient's needs are met. Knowledge of medical and technological expertise are the roots of practical assistance, but direct patient contact is very important as well. It is very easy to think of the "ideal doctor" and picture Robin Williams as Patch Adams- where the ultimate concern is patient contact and patient happiness. In an ideal world, that would be sufficient. However in today's world of HMO's and raving insurance companies, its next to impossible to receive personalized care for any length of time. Consequently, is it fair to judge today's doctor's who are plagued by the restraints of insurance companies in order to protect the financial well-being of their patients? That is in itself another topic.

Dating back to the 4th and 5th centuries B.C., we can see the values written in the Hippocratic Corpus. Within these writings is evident a respect for life, similar to Pythagoras. Ideally, a doctor places his deep knowledges for healing above personal desires, etc. and handles patient matters with utmost concern. The Hippocratic Oath, which many regard as the ultimate in doctor ethics, advocates chastity, patient secrecy, and utmost concern for the patient. As times have changed though, more concern has arisen over that spelled out dictation of what a good doctor is. Is it possible to make specific declarations of what an ideal doctor consists of? "Ideally," a doctor thinks of each patient as important as the others, and treats them all with the fullest extent of her knowledge in hopes to relieve whatever pains them.
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Date: Sun, Mar 12, 2000 4:22 PM From: jkbyrd13@hotmail.com To: DoktorMo@aol.com

In my opinion, the ideal doctor is one who embodies the traits of the Hippocratic Oath. The Oath, often sworn to by graduating medical students, was written with the intent of producing doctors who would inspire trust from their patients and work for the good of humanity. The ideal physician is firmly devoted to his trade. He should have all of the knowledge and skills necessary to be a physician, but he must also care about the patients, and not just the money. I believe that being a doctor is more than just a job, but also a devotion to the betterment of human life.

I do not, however believe that we should follow the Oath verbatim. The Hippocratic Corpus was written in the fifth and fourth centuries B.C. The writers of the Oath could not have forseen the advances that medicine has made and the issues that a physician must tackle today. For instance, doctors today need not practice chastity; very few remain unmarried or do not date, I would think. Also, the Oath prohibits surgery ("I will not cut, even for the stone..."). We would not have such medical success without the new and innovative types of surgery that save lives every day. Furthermore, abortion and physician-assisted suicide are prohibited in the oath, and these are serious topics for discussion in society. It is obvious that the Oath can not effectively be followed exactly.

However, the first promise in the ethical code of the Oath is the basis for modern ethics; the physician swears to help the sick to the best of his or her ability and to abstain from harming. The last promise is the promise of confidentiality, which is vital for doctor-patient trust. The Hippocratic Oath taken word for word is certainly long outdated. A physician need not follow it strictly to be a good one, but he should work to help (not harm) and do all that he can to treat patients and preserve their trust.

Ken Byrd, Student at the University of South Carolina
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Date: Sun, Mar 12, 2000 7:58 AM From: amhames@hotmail.com To: DoktorMo@aol.com

The ideal physician should be primarily concerned with the health of his patients. This is evidenced in documents as early as the Oath of Hippocrates in the Greco-Roman era. In the Oath's ethical code, the physician swears to use his power to help the sick to the best of his ability and judgement. In order to treat patients in this way, a doctor must possess significant medical expertise and be competent in his practice. He must also be equipped with the latest technological knowledge and be able to use it with great accuracy and precision. The Hippocratic Corpus embodies another work, The Canon, regarding the characteristics desirable for a medical student. A portion reads, "Want of skill is a poor thing to prize and treasure...It makes [a man] prone to cowardice and recklessness." The canon also requires the ideal aspiring physician to possess a natural disposition for the practice and knowledge of medicine. This would require compassion, good listening skills, empathy, adaptibility, and sound decision making under pressure and time constraints.

The Hippocratic Oath also addresses issues concerning bedside manner and respect for the patient. Upon taking the Oath, a physician promises to do no harm or injury with intention. The physician also swears not to abuse his power and position when in private situations with his patients. The issue of the right to privacy is also mentioned in the Oath. The practitioner upholding the Hippocratic Oath says what he sees and hears professionally will be kept secret.

The ideal physician should be primarily concerned with improving the human condition. To accomplish this goal, he must put aside religious views which may come into conflict with the patients' treatments. The Canon reads, "Science and opinion are two different things; science is the father of knowledge but opinion breeds ignorance." This has transcended many years of scrutiny and is certainly controversial today. The World Medical Association administers this pledge upon admission into the medical profession. "I will not not permit consideration of religion, nationality, race, party politics or social standing to intervene between my duty and my patient."

The Canon states that there are many doctors in name but few in fact. I agree with this statement completely. I hope that I can be the physician described above, and I plan to practice medicine by the philosophy that the hand that holds is as essential as the hand that heals.
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Date: Mon, Dec 20, 1999 7:20 AM From: Orexis@aol.com To: DoktorMo@aol.com

I became quite excited when I saw this question on the bulletin board.I just wrote my Master's thesis in this area. However, I would like to caution everyone who wishes to reply to your question. I think it is an incomplete question. In the patient-physician dyad, physicians are not the only party who has an active role in the relationship. If someone asks what kind of person a physician ought to be, the answer, if there is one, only addresses half of the clinical encounter. A physician may possess medical expertise, technological precision, and compassion, but these qualities or attributes by themselves do not constitute an ideal relationship between a patient and physician. Responsibilities do fall more heavily on the physician; they are in a practice that professes to heal. However, the patient should not be only a passive recipient of care. The medical literature rarely addressses what kind of person a a patient ought to be. I would not focus so much on that subject. What intrigues me is the relationship as a whole, would would an ideal encounter with a patient and a physician look like? We can submit any formula for ameliorating the clinical performance of a physician, however, the patient needs to be an active part of this performance too. "The Ideal Physician" image is the ancient residue of "The Hippocratic Oath". We need to address both constituents of the clinical relationship.

Melinda Rosenberg
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Date: Wed, Dec 1, 1999 10:54 PM From: rus@rcia.com To: DoktorMo@aol.com

An ideal doctor is one who listens to the patient, the family, the nurse, the CNAs and then makes his decisions. An ideal doctor is not concentrating on being an angel to an internet start-up company.
Date: Thu, Jun 3, 1999 12:13 PM From: Tall Blue@aol.com To: DoktorMo@aol.com

Perhaps there is no simple definition of the ideal doctor. Approaching the bedside, physicians and other providers establish links on a variety of levels. The physician-scientist churns through differential diagnoses the moment he/she walks through the door, taking in the sum of subtle and not so subtle clues. As well, good clinicians learn to establish human links quickly. The best clinicians I've known in my career recognize the reflection of all life in each patient. As such, patients often easily lend to such persons intimate details of their illness. These clues, and others, enable the "technically prepared" clinician to soar beyond simple clinical competence to an ew level as "healer" rather than technician. As healer and patient take this journey together, they dance an intimate, human waltz which opens new doors to consciousness for both. Such interactions are sometimes brief and sometimes quite long. In either case, both learn more about the nature of suffering. In so doing, each is doctor and each is patient.
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Date: Tue, Apr 20, 1999 8:27 PM From: randyh@raex.com To: DoktorMo@aol.com

a good doctor is one that gives kids lollipops and has ear hair...you know...the ones that make you feel good about yourself even when you're feeling bad. all because he knows how to feel good about himself and being able to respect ALL of his patients.

Susan
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Date: Tue, Dec 8, 1998 7:23 PM From: rcy@po.cwru.edu To: DoktorMo@aol.com

I came across a link I had not visited before: What is an Ideal Doctor?

I noticed that many of the responses focused on competence and caring. Personally, I believe most of us who choose this profession do so because we care about improving the human condition (maybe the aloofness patients see in their doctors is just a defense mechanism -- it's difficult to always be human when there are people who die and suffer needlessly). And I doubt that most doctors could practice without some modicum of medical mastery. However, as I think back to the many posts I have read on the bioethics page, I've come to the conclusion that being a caring doctor is not enough.

Four years from now when I become a doctor (how's that for confidence, huh? hahaha!), I will be faced with new technologies, dilemmas, decisions. Yet the caring healer as the paradigm to follow opens up a medical Pandora's box full of questions which cannot be neatly answered. What does it mean to care for a patient? Sometimes what will apply to one patient will not necessarily be best for another. So, for me, after exploring this site, I believe the ideal physician is one who is **adaptable**.

The art of medicine is changing at a much faster rate that ever before in its history. What awaits us we cannot prophesy its exact nature. The ideal physician will be someone, who has empathy, who is competent, and who, despite posessing a strong code of ethics, has the courage to accept a different code which may be incongruous to their own. It's a tall order: to be human and masterful and wise like Solomon!

---oOo---oOo---oOo---oOo---oOo---oOo---oOo---

Raechelle C. Yballe, Case Western Reserve University, Cleveland, Ohio
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Date: Fri, Mar 27, 1998 11:07 PM From:tweed@pe.net To: DoktorMo@aol.com

I work daily with doctors. I find most of them to be competent and genuinely concerned about the well-being of those they treat. What I find lacking among many physicians, however, is the capacity to be human toward their patients.

This usually is through no fault of their own. Doctors are trained early in their careers to discount their emotions when treating patients. Physicians are taught to cure rather than care. The most powerful tool available to physicians today, however, is the ability to express what is in their hearts for their patients.

How many physicians today truly greet patients as they would a beloved friend? How many physicians today use the art of listening for its capacity to heal rather than as a tool for simply gathering information? How many physicians today would gently stroke the hair of a seriously ill, adult, same-sex patient--and admit it to their peers?

Yes, I want a doctor who is smart. Yes, I want a doctor who keeps abreast of the latest medical technology and therapies. And, yes, I want a doctor who can cure me if at all possible. But what I want most of all is a doctor who has the genius to provide me his humanity.

Sincerely, D. Dredla
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Date: Sat, Feb 21, 1998 3:30 PM From: cobbatcls@juno.com To: DoktorMo@aol.com

A good doctor is someone who knows how to heal themselves, physically, mentally,and spiritually. The only possible way to achieve this is to get to the core of who one is. This is not something that is learned in the confinements of the classroom. This is an adventure into the very existance of a the human life force in which we have spawned from. This is a journey that leads us to the universal truth that lyes within all of us. It is almost as if the layers of society have to be striped from us in order to expose the truth that lyes beneath. A good doctor is someone who has stripped themselves of all of societies layers and discovered the truth. Once the universal truth has been reached,I believe a special talent unique to that individual will be felt. If that talent happens to be to heal, then so be it a healer.
Date: Tue, Jan 20, 1998 7:22 AM From: yzafar@geocities.com To: DoktorMo@aol.com

Basically, three qualities are most important to me. I want my physician to be:

1) competent, 2) caring, 3) communicative

Still, Ii would agree with the previous poster who said that the balance of characteristics or skills depends on the physician's specialty.

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Date: Tue, Dec 16, 1997 7:31 PM From: EAKR07F@prodigy.com To: DoktorMo@aol.com

The question is so general that one can answer it in only the most generalized of terms. We seem to ask questions in terms of the kindly old family G.P. when, in fact, there is great differentiation in the practice of medicine. So, in the most general of ways, my priority is that my physician be competent, i.e., very competent, and I would reject the incompetent. Beyond this, I would opt for interpersonal qualities, morality, etc. But this mixture might vary somewhat depending on the situation/specialty. Competence might be somewhat more important to me if my physician was my neurosurgeon as opposed to my G.P. Generally, however, I think that we are mistaken in talking about "the doctor" and we might be advised to speak about "doctors."

4 Comments:

At Thursday, May 18, 2006 9:09:00 PM, Anonymous Moof said...

Thank you for this post, Dr. Bernstein. I've been struggling with this question for two days now ... and here, you post about it! It's uncanny ...

Each person will define a perfect doctor from their own unmet needs, I think ... and hopefully also from the example of physicians who have positively impressed them at some time in the past.

I believe that, over and beyond the basics - knowledgeable in his field, capable, attentive to detail, etc. ... there are a few other qualities that aren't always seen ...

The first thing, for myself, would be - I want to know that he's human. I want to feel that I communicate with him not only as a physician, but also as a person. If that doesn't happen, there's no chance that I'll ever be able to be forthcoming with him. For myself, that's basic.

Also - the ideal physician wouldn't be afraid to use the term: "I don't know," if it happened to be the true answer. That would give me confidence in his honesty, and would give me the comfort of knowing that he understands his humanity, and his own limits - which would in turn help me to be realistic about what he can, and can't, do for me.

The ideal doctor would allow a bit of who he is beyond his profession to leak through ... after all, I'm expected to be completely candid with this person, perhaps even about things I don't tell my own husband.

The ideal physician would listen as closely to the things that aren't said - as to those that are.

There is a doctor here that I've never seen for myself, but who has a reputation whever he goes. When he visits the nursing homes, he stays behind going over charts, speaking individually to the nurses to make sure that this patient gets a walk in the afternoon ... and that this other one gets a shower because she's really uncomforable by evening otherwise ...

The nurses are in awe of him. That says a volume.

His patients have good things to say about him too. Someplace, somehow, this fellow has hit it somewhere near right.

Now ... Dr. Bernstein ... you ask a lot of questions, but you seldom speak about yourself.

To you, what is an ideal patient?

 
At Thursday, May 18, 2006 9:40:00 PM, Blogger Maurice Bernstein, M.D. said...

Moof, on August 3,2004.I wrote about my (as well as what other physicians think)consideration of an "ideal patient".
So you don't have to link back to the posting, I will reproduce it here now and then to top off this subject, I will follow that with satire lyrics by Dr. Steven Miles "A Hymn to Him" from "My Fair Lady". This was from the posting August 5, 2004 titled "Why Can't a Patient Be More Like a Doc?"
I hope this answers your question. ..Maurice.


In my posting on July 30th mention was made of an "ideal patient". What do you think is the physician-view of such an ideal patient? Well, as physicians, though we would like to think of caring for an ideal patient, we have to face the reality that this would rarely happen. You see, the ideal patient would be one who, first of all, bears many of the views and goals of the physician. As physicians, we really can't believe that we will be so lucky. Then, physicians generally yearn for illnesses which they can easily diagnose and readily treat to an outcome which is optimal for the patient. That usually means that the patient has real physical symptoms, one acute disease-- not confusing multiple new diseases at the same time and, finally, clear cut physical findings and lab tests. The illness, hopefully, would have standard treatment which is virtually universally satisfactory and the risks of treatment being minimal, if at all. The patient should be alert, in good spirits (not too sick), have confidence in the physician, readily competent to make decisions, thoroughly interested in learning about the illness and its treatment and willing to take time to listen carefully to the explanation by the physician and the options of further diagnostic tests and treatment. And when it comes to treatment, the ideal patient will make the effort to follow the physican's prescription directions and remain fully complient. The patient will also carefully monitor their reaction to the medication and promptly report to the physician any side-effects or complications. The ideal patient will also have the ideal family. Such a family will support the patient but also show confidence in the physician and support the physician.

As I mentioned at the outset of this posting, this all may be just wishful thinking on the part of the physician. It is unlikely that all these features would appear in the one patient. However, if the doctor had repeatedly such ideal patients, caring for them might be a boring experience. The wonderful "goose-bump" experience of a physician suddenly finding that he/she has made an emotional/spiritual connection with a patient would no longer occur. The wonderful challenge of the difficult diagnosis and the emotional uplifting for the physician who has made the diagnosis that was missed by others, even specialists, would be missing. The splendid realization of a cure, finally occuring after a course of many ups and downs, would be a rarity if all cures occurred easily and on schedule. Finally, if the physician had all ideal patients, the challenge of the difficult patient, the difficult family and the challenge of managing the patient and family if the cure doesn't come will be absent.

It is the job of a physician to make the diagnosis when the illness is not easily identified, to make the patient's treatment satisfactory when that isn't easy or simple and finally to meet the criteria and be that ideal doctor to every patient who turns out not to be the ideal patient imagined by the physician.


And now from Dr. Miles, the satire:

A HYMN TO HIM


Why can't a patient be more like a doc?
Docs are so honest, so thoroughly square;
Eternally noble, historic'ly fair;
Who, when you win, will always give your back a pat.
Well, why can't a patient be like that?
Why does ev'ryone do what the others do?
Can't a patient learn to use her head?
Why do they do ev'rything other patients do?
Why don't they grow up- well, like their doctor instead?

Why can't a patient take after a doc?
Docs are so pleasant, so easy to please;
Whenever you are with them, you're always at ease.

One doc in a million may shout a bit.
Now and then there's one with slight defects;
One, perhaps, whose truthfulness you doubt a bit.
But by and large we are a marvelous lot!

Why can't a patient take after a doc?
Cause docs are so friendly, good natured and kind.
A better companion you never will find.

Why can't a patient be more like a doc?
Docs are so decent, such regular chaps.
Ready to help you through any mishaps.
Ready to buck you up whenever you are glum.
Why can't a patient be a chum?

Why is thinking something patients never do?
Why is logic never even tried?
Questioning me is all that they do.
Why don't they straighten up the mess that's inside?

Why can't a patient behave like a doc?
If I was a patient who'd been offered a cure,
Hailed as a miracle by one and by all;
Would I start weeping like a bathtub overflowing?
And carry on as if my home were in a tree?
Would I run off and never tell where I'm going?
Why can't a patient be like me?

 
At Friday, January 12, 2007 11:44:00 AM, Anonymous Anonymous said...

To me, one word characterizes the ideal doctor:

Thoroughness

The thing that I find more frustrating than anything else is the astonishing lack of thoroughness I've seen from doctors in the last 10-15 years.

I have completely stopped asking for physical exams because doctors simply won't do a thorough physical checkup any more. The last two doctors I went to to ask for a physical exam did not even ask me to remove my shirt. One did *NOTHING* except 3 or 4 simple behavioral tests to check for neurological problems. The doctor I went to before those two at least had me pull up my shirt to check my heart rate.

I even asked the last one to give me a complete, thorough physical and he told me I didn't need it. Excuse me? I told him that I had not had one in years and he replied that I was only 35 and that I didn't need to worry at my age.

That's funny -- when I was 20 and asked for a complete physical, I got a good, thorough physical. Am I to believe that an 20 year old needs checkups and a 35 year old doesn't?

In my opinion, if I go into a doctor's office and ask for a "thorough physical" and the doctor does virtually nothing, he should have no legal right to accept payment for the visit.

It's not just physical checkups, either. I have noticed this time and time again in recent years -- doctors just aren't thorough any more. They don't order tests that, 15 years ago, they would have.

My mother and two of my closest friends died lingering, painful deaths to cancer. In all three cases, they had been to the doctor and complained of symptoms a month or more before they were actually checked for cancer. In all three cases, they were patted on the head and sent on their way -- no tests conducted.

I realize that the rise of MISmanaged health care is largely responsible, but I don't think doctors can be completely forgiven here. Even if insurance won't pay for a particular test, shouldn't the patient be offered it anyway?

Is there some reason why the doctor can't say, "Insurance won't pay for this test, and you're probably fine without it, but if you want me to run it just to be safe, I will. It will cost you around $______." I don't want doctors to just decide for me what risks I should take with my life to save money.

 
At Friday, January 12, 2007 6:14:00 PM, Blogger Maurice Bernstein, M.D. said...

Selecting whether to order a test and what test to order is the physician's professional responsibility. It is also the physician's responsibility to inform the patient what would be the appropriate testing irrespective of the cost. The cost-benefit relationship must be decided by the patient with the help of the physician. Alternate,less expensive tests, can be discussed with the physician's input regarding their diagnostic value. In the final analysis, it is the informed consent of the patient that is awaited. ..Maurice.

 

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