What separates good doctors from bad ones?

In June 2018, famed physician author and public health researcher, Atul Gawande, MD, MPH, gave the commencement speech at UCLA School of Medicine. The speech was widely lauded for its incisive commentary on the values physicians ideally bring to medicine. One virtue he stressed was the ability to recognize humanity in all patients.

“Without being open to their humanity, it is impossible to provide good care to people—to insure, for instance, that you’ve given them enough anesthetic before doing a procedure,” said Dr. Gawande. “To see their humanity, you must put yourself in their shoes. That requires a willingness to ask people what it’s like in those shoes. It requires curiosity about others and the world beyond your boarding zone.”

The ability of a physician to seek out the thread of humanity that runs through every interaction is merely one defining attribute of a good (or great) physician. Here are some other traits that distinguish good physicians from their not-so-good counterparts.

Empathy

For some time, empathy has become a buzzword of sorts among medical educators and clinicians, and with good reason—empathy is integral to rapport building between healthcare providers and patients.

“Higher physician empathy scores are associated with higher patient satisfaction, better patient clinical outcomes, and fewer medical litigation actions,” wrote the authors of a study published in PLOS One. “Patient satisfaction has been associated with provider empathy in previous studies. Higher patient perception of physician empathy scores have been associated with higher patient satisfaction in a primary care setting and higher provider self-reported empathy has also been observed with better patient satisfaction among otolaryngology residents.”

In this prospective observational study, the authors extended these findings to the emergency department (ED) by surveying 1,308 ED patients concerning the interplay between physician empathy and patient satisfaction. Of all the providers, emergency medicine residents had the lowest empathy scores, while senior attending physicians had the highest scores. Emergency medicine residents also had the lowest number of “very satisfied” responses (65%) compared with senior attendings who had the highest number of “very satisfied” responses (69%).

“This study provides evidence of a positive association between ED provider self-reported empathy and after-care instant patient-to-provider satisfaction. Overall higher empathy scores were associated with higher patient satisfaction,” they wrote. 

Read more about how compassion can make you a better doctor and even improve patient outcomes, according to studies.

Curiosity

In an article published in Family Practice Management, Kenny Lin, MD, MPH, claims that curiosity separates good from great doctors. With respect to curiosity, he is not, however, referring to the science of doctoring. 

“Yes, the knowledge base for medicine is always expanding, but as I tell students, regardless of what field of medicine you choose, the technical aspects eventually become routine,” he said. “Even emergency and family physicians, who encounter the largest variety of symptoms and diagnoses, get acclimated to bread-and-butter encounters: back pain, chest pain, respiratory infections, and the management of common chronic conditions. What keeps my work meaningful is learning about the details of my patients' lives that aren't strictly medical.”

He cited literature that put forth the notion that curiosity transforms strangers, or “objects of analysis,” to people who can be empathized with. He also noted that to truly know a patient, it’s important to understand their characters, cultures,  environment, spirituality, physical responses, and past experience.

Communication

Above all, good physicians are good communicators. Effective communication refers to verbal speech or other ways of conveying information to establish a message and support patient insight. If either the patient or the physician fails to understand the purpose of the information relayed, then communication is ineffective. 

Communication is bidirectional, according to the author of an article published in the Harvard Public Health Review. In terms of the patient-system interaction, there are three components delineated. First, patients need to be able to present information about their health complaints to the physician and healthcare team. Second, the healthcare team must be able to comprehend and interpret this information to treat these complaints. Third, the physician and healthcare team must be able to communicate information to patients to prevent recurrence of health complaints. 

“If any of the aforementioned steps of this process is compromised, healthcare delivery becomes ineffective,” wrote the author. “Ineffective healthcare delivery increases the likelihood of negative patient outcomes. It also increases patient utilization of inpatient and emergency care. Consequently, the burden of cost on healthcare systems increases.”

In situations where health literacy and language comprehension aren’t an issue, establishing effective patient communication may require keeping certain strategies in mind. For instance, consider the RESPECT model, which we summarize in the following key points:

Rapport. Attempt to connect with the patient on a social level and see their point of view in a nonjudgmental manner without assumption.

Empathy. Keep in mind that the patient needs your help. Acknowledge their feelings, and endeavor to understand the rationale underlying their behaviors or illness.

Support. Attempt to understand any barriers to care and compliance, and attempt to overcome these barriers. Additionally, involve family as necessary and assure the patient that you are there to help.

Partnership. Remain flexible with respect to issues of control with the patient. Vocalize that you will work with the patient to address medical complaints, and negotiate when necessary.

Explanations. Ensure that the patient understands your guidance by clarifying verbally.

Cultural competence. Respect the patient’s worldview, culture, and beliefs, and understand that these may differ from your own. Additionally, recognize cultural differences, and remember that your personal approach may not always jibe with any given patient.

Trust.  Put in enough time to gain your patient’s trust. Also, recognize that some patients may not disclose their problems easily due to cultural differences. 

Listening

With bloated caseloads, most physicians have little time to waste. Although lunch breaks and leisure activities are often places where physicians claw back time for patient care, taking time to actively listen should never be compromised.

“Actively listening conveys respect for a patient’s self-knowledge and builds trust, and allows physicians to assume the role of trusted intermediary,” according to the authors of an article published in the Harvard Business Review.

Modern medicine’s true healing potential depends on a resource that is being systematically depleted: the time and capacity to truly listen to patients, hear their stories, and learn not only what’s the matter with them but also what matters to them,” the authors wrote. “Some health professionals claim that workload and other factors have compressed medical encounters to a point that genuine conversation with patients is no longer possible or practical. We disagree.”

The authors noted that actively listening to patients conveys respect for patient opinions and knowledge, and builds trust. By means of shared knowledge, physicians and patients can forge a viable plan of care. Skimping on active listening may lead to ineffective/undesired treatment, or lead to the loss of valuable information. Moreover, these repercussions also reduce the gratification of being a physician and play a role in burnout.

Bottom line

Becoming a good doctor requires years of insight and hard work. Unfortunately, there is no magical formula to excel in patient care. By remaining mindful of the importance of empathy, curiosity, communication, listening, and more, you can lay a path to excellence and greater satisfaction. 

Learn more about other qualities that every good doctor must have, including honesty, competence, commitment, and more.