How can I be a Good Doctor?

In a recent blog post from Ashish Jha, Harvard Medical School, he asks what seems like a simple question: What makes a good doctor and can it can it be measured? How would a hospital or patient go about answering this question?  Is it an evidence based question that can be measured using clear criteria such as “good hemoglobin A1C control, regular checking of cholesterol, effective LDL control, smoking cessation counseling, and use of an ACE Inhibitor or ARB in subsets of patients with diabetes”, or is there something more that borders on the art of being a doctor?

In short how do we understand the disconnect between what can be measured in “hard” data, and the “soft” skills that we associate with the art of being a doctor- communication, compassion and teamwork for example.

Dr Jha wrestles with this disconnect between measurement and craft. He writes:

“…when I think about great clinicians that I know – do I ask myself who achieves the best hemoglobin A1C control? No. Those measures – all evidence-based, all closely tied to better patient outcomes –don’t really feel like they measure the quality of the physician.”

The same “soft” skills that patients demand from their doctors  are also demanded from the contemporary healthcare institutions we work in.  What are the qualities of a doctor that allow an institution to change, grow and address patient need?  If we can describe these qualities of a  good doctor, perhaps we could understand what motivates doctors and begin to address the low moral documented among our members inn a recent Doctors Council survey.

Paradoxically, asking what makes a good doctor highlights the limits of the doctor’s role, and the frustrations that doctors feel about those limitations. According to a 2011 Robert Wood Johnson study:

“4 in 5 physicians surveyed (85%) say patients’ social needs are as important to address as their medical conditions. This is especially true for physicians (more than 9 in 10, or 95%) serving patients in low-income, urban communities.”

How can the doctor trained in the medical encounter address these issues, and if they can not, what tools and skills does the doctor need to strive in an environment which such limitations.

“Even though physicians say social needs are just as important to address as medical conditions, only 1 in 5 physicians surveyed (20%) feel confident or very confident in their ability to address their patients’ unmet social needs.”

Is there a role for Doctors Council in addressing this gap between a clear social diagnosis and the limitation of the medical encounter?

“Physicians in this survey reported that if they had the power to write prescriptions to address social needs, such prescriptions would represent approximately 1 out of every 7 prescriptions they write”

Doctors Council needs to help doctors write these social prescriptions, not as an add-on to doctor work, but as part and parcel of what it means to be a doctor working in a public hospital system.

Another way of getting at this issue is to ask does the change in both the health care delivery system and how health care payment works affect the concept of medical professionalism?  The growing consensus seems be that professionalism must move beyond the walls of the examination room.  Over 10 years ago the Medical Professionalism Project published “ Medical professionalism in the new millennium: a physicians’ charter” which include a “Principle of Social Justice

“The medical profession must promote justice in the health-care system, including the fair distribution of health-care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.”

The charter also included a “Commitment to improving access to care”

“Physicians must individually and collectively strive to reduce barriers to equitable health care. Within each system, the physician should work to eliminate barriers to access based on education, laws, finances, geography, and social discrimination. A commitment to equity entails the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician, without concern for the self-interest of the physician or the profession.”

The old professionalism was an individual ethos directed toward a doctor and a patient.  The new professionalism asks about the power of doctors to affect the health of their patients outside of the examination room.

We welcome your comments on the role Doctors Council can play in promoting this new professionalism.

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