PCPs like people. This was true of them long before
they started medical school and it will have only blossomed further during
training. Ask PCPs, as I have with in-depth interviews, and they will tell you
that certain types of individuals are drawn to primary care careers; they have
common characteristics. They like to converse with people. They enjoy getting
to know about a person – their ideals, their goals in life, their ambitions,
their cares and sorrows. They are interested in learning from the patient
rather than talking down to the patient; their ego can be strong but not as to
impose themselves on the patient. They tend to not only want to know their
patient but also to understand his or her place in their family and society. He
or she is a person who wants to know the “whole story;” they tend to see the
patient as a whole person, as part of a family and part of a community. They
see the patient as a unique individual and his illness as part of that totality
of the person, not just a diseased organ or system. To paraphrase Sir William
Osler, a good doctor tends to the person who has a disease rather than just the
disease itself.
PCPs generally like to engage in an intellectual
puzzle, a mystery to solve. They have a
“general contractor” mentality meaning that they see themselves as capable of
getting much or even most of the job done themselves but are comfortable in
drawing in others as necessary and in so doing are committed to coordinating
everyone involved in the patient’s care. As with all of us, they wish to earn a
good income but money is not the most important thing in their life nor is it
what drove them to become physicians.
What are the characteristics of a good physician?
The deputy dean for education at Yale Medical School, Richard Belitsky, M.D.,
talked to the freshman class a few years ago at their White Coat Ceremony about
becoming
a doctor. Greatly abbreviated, he told them there was much
to learn “but so much of what you need to be really good doctors, you already
know… Becoming a great doctor begins not with what you know, but who you are.
Being someone’s doctor is about a relationship. That relationship is built on
trust…Being a great doctor begins not with what you have to say, but your
ability to listen.”
In my interviews, primary care physicians report
that listening is the key and most important attribute of being a good
physician in primary care. By listening they mean one who listens to the
patient’s story without rushing it and without embellishing it. They let the
patient develop his or her own story of their situation perhaps with some
prompts to help them focus but without unduly narrowing the narrative. The PCP
must at the same time be nonjudgmental if he or she is to learn from the
patient and develop a strong doctor patient relationship – the third major
attribute. PCPs need to like people and
thus like their patients. The good PCP
is well grounded in basic medical science, the latest in evidence-based care
and is constantly seeking continuing education. The good PCP is conservative,
meaning that he or she will work with lifestyle, behaviors and other measures
such as nutrition or exercise before resorting to drugs or procedures. This
requires patience; not everything can be “fixed” immediately. They feel that
knowing the patient over the long term aids the care process and enhances the
doctor patient relationship as does being attuned no only to the physical needs
but also the patient’s emotional and spiritual requirements. Knowing the
patient’s family not only helps to understand the patient but they will be the
physician’s ally if and when needed later. It is important to attend to the
patient in the same manner that one would want to be treated by others.
Combined, these will develop trust, respect and partnership. Some will not only
be very good physicians but also true healers, a desired state that only some
attain.
A physician who saw this post previously commented
that I forgot two things – leaping tall buildings in a single bound and being a
good typist. The problem of course is that PCPs today do not have enough time
with their patients so even if they possess all or most of these
characteristics they are trapped in a business model that does not value time.
When a general audience on LinkedIn
was asked by Paula Stanziani what in one
word constitutes a good doctor the answers varied of course but some of the
most noted common attributes are these: Listener, commitment, compassion,
humanity, attentive, patient, competent, teacher, healer and ethical. A good
overview from one respondent, Scot Sturtevant, was “I’ve met many a physician
in 36 years of service. Some brilliant, some not so much. The one thing I have
noticed though those that were great, truly great, were those who were humble,
but confident. They would listen quietly to a patient's story, and were never
really rushed nor found themselves panicking in a critical situation. They were
stoic yet responsive, and treated nurses, technicians and even field medics as
a valued part of the team. To sum it they know who they are, and where they
came from... And like all of us, still put their trousers on one leg at a time.
There really isn’t a single word to describe greatness, it’s part of the
diverse nature of who they are and how they apply what they've learned and what
they know.”
That sums it up well for me.
Next post: The frustrations of being a primary care
physician.
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