Here She Comes Again Like Good Medicin
BMJ. 2002 Sep 28; 325(7366): 711.
What's a adept doctor and how do you make one?
Doctors should exist good companions for people
Murray Enkin, consultant
Centre for Global eHealth Innovation, University Health Network, Toronto, Canada M5G 2C4
Editor—Imagine waking tomorrow to find a magic lamp by your bed, and the genie tells you that there is only one wish left. You determine to devote it to making good doctors. What kind of people would these practiced doctors be?
We ask this question oftentimes among ourselves—a doctor embarking on his career, an active researcher approaching his peak, and a retired clinician needing geriatric care. We sometimes inquire other people too. Despite the disparate vantage points, the wish lists are amazingly similar. We all desire doctors who will:
-
Respect people, good for you or ill, regardless of who they are
-
Support patients and their loved ones when and where they are needed
-
Promote health likewise every bit treat disease
-
Embrace the power of data and communication technologies to back up people with the best available information, while respecting their individual values and preferences
-
Always inquire courteous questions, allow people talk, and listen to them advisedly
-
Give unbiased communication, let people participate actively in all decisions related to their wellness and health care, assess each state of affairs carefully, and help whatever the state of affairs
-
Apply evidence as a tool, not every bit a determinant of practice; humbly accept death every bit an important office of life; and help people make the best possible arrangements when decease is close
-
Work cooperatively with other members of the healthcare team
-
Be proactive advocates for their patients, mentors for other health professionals, and ready to learn from others, regardless of their age, function, or status
Finally, nosotros want doctors to have a balanced life and to intendance for themselves and their families as well equally for others. In sum, we desire doctors to be happy and healthy, caring and competent, and proficient travel companions for people through the journey we telephone call life.
Unfortunately, we do not have a magic lamp, and there is no genie. We must use our own skills and endeavours to make the good doctors we want and need. Information technology is an awesome responsibility.
2002 Sep 28; 325 (7366) : 711.
ABC of beingness a good physician
Editor—I offering some quotations on being a expert doctor.
"To be a doctor, then, means much more than to dispense pills or to patch upward or repair torn mankind and shattered minds. To be a md is to be an intermediary betwixt man and GOD" (Felix Marti-Ibanez in To Exist a Doctor).
"One of the essential qualities of the clinician is involvement in humanity, for the secret of the care of the patient is in caring for the patient" (Frances W Peabody in The Care of the Patient).
"Being a good doctor ways being incredibly compulsive. It has goose egg to do with flights of intuition or brilliant diagnoses or even saving lives. It's dealing with a lot of people with chronic diseases that you really can't change or improve. You can aid patients. You tin can make a difference in their lives, only y'all do that mostly by drudgery—twenty-four hours afterwards 24-hour interval, paying attending to details, seeing patient after patient and complaint afterward complaint, and beingness responsive on the phone when you don't experience like being responsive" (John Pekkanen in Physician—Doctors Talk Nearly Themselves).
"You tin't know it all. And even if yous knew everything that anyone else knows (which you can't, and then stop worrying about it), y'all still wouldn't know what you need to know to aid many patients" (Perri Klass in A Not Entirely Beneficial Procedure).
Some of the qualities that a good md should possess are measurable, others are not. A skilful doctor should be:
A: attentive (to patient'south needs), analytical (of cocky), authoritative, accommodating, adviser, outgoing, assuring
B: counterbalanced, believer, bold (nevertheless soft), brave
C: caring, concerned, competent, empathetic, confident, creative, communicative, at-home, comforter, conscientious, compliant, cooperative, cultivated
D: detective (a good doc is similar a good detective), a good give-and-take partner, decisive, delicate (don't play "God")
E: ethical, empathy, effective, efficient, indelible, energetic, enthusiastic
F: friendly, faithful to his or her patients, flexible
G: a "practiced person," gracious
H: a "human existence," honest, humorous, humanistic, humble, hopeful
I: intellectual, investigative, impartial, informative
J: wise in judgment, jovial, just
K: knowledgeable, kind
Fifty: learner, good listener, loyal
M: mature, modest
N: noble, nurturing
O: open up minded, open up hearted, optimistic, objective, observant
P: professional, passionate, patient, positive, persuasive, philosopher
Q: qualified, questions cocky (thoughts, behavior, decisions, and actions)
R: realistic, respectful (of autonomy), responsible, reliever (of pain and anxiety), reassuring
Due south: sensitive, selfless, scholarly, skilful, speaker, sympathetic
T: trustworthy, a great thinker (specially lateral thinking), teacher, thorough, thoughtful
U: agreement, unequivocal, up to date (with literature)
V: vigilant, veracious
Due west: warm, wise, watchful, willingness to listen, learn, and experiment
Y: yearning, yielding
Z: zestful.
2002 Sep 28; 325 (7366) : 711.
Proficient doctors grow
Editor—It is fairly piece of cake to define in a few words what makes a skilful lawyer, a good architect, or a expert writer, by saying that it is ane who wins difficult trials, who builds the best constructions, or who writes moving novels—no more qualities would exist absolutely necessary. In dissimilarity, to define what makes a good doctor is a rather hard chore.
A good dr. is not one who cures the near considering in many specialties recovery is not a frequent effect. It is not ane who makes the best diagnosis because in many cases of cocky limited or incurable disorders the precise and timely diagnosis does not make a neat deviation for the patient. It is not ane who knows more scientific facts considering in medical science ignorance is still rampant in several diseases. It is non one who is gentle, compassionate, and honest with the patient because these qualities are often bereft for an effective medical class of action. Information technology is non 1 who discovers a new fact or handling because nowadays new data is only a pocket-size fraction of knowledge to be inserted in the enormous puzzle of biomedical research.
Other professionals tin be judged by their end results, simply a doctor can be defined as good only when he or she has as many as possible of the above attributes. A good doctor is simultaneously learned, honest, kind, humble, enthusiastic, optimistic, and efficient. He or she inspires full conviction in patients and daily renews the magical human relationship that by itself constitutes proficient treatment for any kind of ailment and the best starting indicate for confronting all causes of pain and suffering. Although so many virtues are hard to find in a unmarried human being, the medical profession is fertile footing for finding such combinations. Fortunately, in our profession good doctors abound.
2002 Sep 28; 325 (7366) : 711.
Some magic is required
Editor—As I think about the by when doctors were soothsayers, astrologers, historians, philosophers, artists, and then on, my feeling is that to be a physician requires a lot of scientific discipline but also a trivial bit of "magic."
Where does this magic come from? Well, it is a outcome of being a complete, integrated person trying to help other people past being understanding and caring but besides knowledgeable, prepared, and ready to give your best—not to salvage lives just to make them every bit good as possible.
Merely why do I consider information technology a gift, or compare it with magic? There is non a single slice of evidence or the means to measure whether a physician is adept or bad. Patients demand knowledge, but that is non all. They need someone who cares about people, non about illnesses.
Every bit a recently qualified medico, I consider myself ignorant in many means, but I know my limitations, and I hope to become better for the adept of my hereafter patients. A good dr. should always admit that he or she is human and has limits, merely these boundaries must not stunt us. Secure in the knowledge that our boundaries brand u.s. strong, we may excel, trying always to be improve every bit man beings and doctors.
2002 Sep 28; 325 (7366) : 711.
Nosotros are trying to brand doctors as well good
Editor—Nosotros are trying to make doctors besides skillful today, and that is the problem. Medical training demands that doctors master at to the lowest degree the nuts of a host of scientific disciplines—anatomy, pharmacology, molecular biology, computer science, epidemiology, nutrition and diet, psychology, and so on. At the same time, they are asked to exist insurance specialists, anthropologists, ethicists, wedlock counsellors, small business owners, social workers, economists—the range of disciplines nosotros ask our medical students to consider is staggering.
The guilt is poured on as articles appear almost every day in the literature, lamenting how little doctors know near some important effect or another—doctors miss depression, don't inquire about sexual behaviours, misunderstand familial corruption, don't know enough about subcultural beliefs, oasis't been brought upwards to date on the functioning of the (fill in the bare) organisation, accept not read up on drug interactions, ignore patients' spiritual needs, and on and on. Doctors reel nether the latitude of expertise they are supposed to primary.
As society becomes increasingly medicalised, and more than and more social problems that used to be the jurisdiction of constabulary or religion (such as drinking also much alcohol or coping with stress, street violence, or general globe weariness) fall under the rubric of medical care, doctors are expected to understand more than and more than as they heal our social and our physical failings. Doctors simply cannot assimilate so much information, or at least they cannot assimilate information technology well. The truly proficient doctor must, of course, be technically proficient and know the craft of medicine. In addition, yet, the skilful doctor must exist able to empathize patients in enough latitude to telephone call on a community of skilled healers—nurses, social workers, insurance specialists, yoga teachers, psychotherapists, technicians, chaplains, any is necessary—to assistance restore the person to wellness (or mayhap, to back up the person in their journey towards death).
To do that, the doctor must be able to exist touched past the patient's life as well as his or her illness. The medico need not be an anthropologist just must know how to enquire about a person'south culture; he or she need non exist a marriage counsellor but must exist able to spot the signs of spousal abuse or the depression that may exist the result of a failing union. Good doctors are humble doctors, willing to mind to their patients and gather together the total array of resources—medical, man, social, and spiritual—that volition contribute to their patients' healing.
2002 Sep 28; 325 (7366) : 711.
Tools of the merchandise must be put to practiced use
Editor—Good doctors must be able to put their tools to good use. With their ears, they must hear all that the patient tells. With their optics, they must see all that the patient shows. With their easily, they must feel all that is hidden from their optics. With their mind, they must detect all that is unspoken. When all this data has been alloyed, they must use their mouths to tell patients their thoughts and their trunk language to reassure. All the time, remembering their duty to the patients.
Information technology must exist remembered that as a profession, nosotros take the highest ideals and standards to uphold. We can practice this only when nosotros ourselves are well trained, take the appropriate time with the patient, and take patients who call up their duty to united states of america too.
2002 Sep 28; 325 (7366) : 711.
Medical profession needs input from conventionalities in humanity and ethics
Editor—In the developing world with its deficient facilities and patients who need to swallow before they need medical care, the medical profession needs input from a conventionalities in humanity and the ideals of the job more than scientific professionalism.
A skilful doctor needs to develop an affluence of patience; to explain and educate before prescribing drugs; and to remember well-nigh the proper decision—this does not e'er have to be what is written in the textbooks. Plush investigations that confirm only what history and examination have discovered accept no identify, and neither accept investigations that would not alter management.
The choice of treatment of a patient who cannot pay immense costs as well needs special consideration, equally does that of a patient who has to travel long distances to reach appropriate care. Taking fourth dimension to explain and understand, choosing the language to fit each and every patient, is non taught in medical school. Deciding to expect rather than to interfere, when interfering in a scarce and likewise short lived manner would only prolong suffering, sharing the sufferings from illness not but in a biological but in a social sense these are skills that a good doctor definitely needs but is not always successful in developing.
Recognising your limits and interim just within them and giving yourself the adventure to proceeds relief and regain energy are sometimes more important than just hanging around helplessly in a busy ward. Honesty and humility—the slogan of my medical school in Khartoum—are easy to write and say but very hard to practice in an overpressed emergency department where tiredness and nervousness proceeds the upper hand.
2002 Sep 28; 325 (7366) : 711.
Being a patient helps
Editor—Aside from the obvious benefits of a fine medical school, great teachers, and lots of hands on clinical experience, I think the very all-time style to produce a adept (sympathetic and humane) doctor is to force student doctors or residents to become patients.
I believe every doctor in pupa should have many tubes of blood drawn over a few days by poor phlebotomists, have a nasogastric tube inserted once or twice, undergo a thorough sigmoidoscopy, barium enema, and bowel preparation, and perhaps even exist made to spend a night or ii confined to a hospital bed, plugged into an intravenous drip, and then be subjected to harried and uncaring staff doctors and nurses while bedridden.
I'll bet a case of wine that this trenchant exercise will produce far more compassionate, sympathetic, and good doctors and then multiple lectures on sensitivity and humanism by some medical academic, ethics professor, or member of the cloth. I daresay that I truly believe that my experiences of being a patient as a student sure every bit hell helped mould me into the caring and sensitive practitioner I am today!
2002 Sep 28; 325 (7366) : 711.
A nurse speaks
Editor—From a nurse's point of view, existence a good dr. is not that hard. Good doctors have graduated from medical school then should have a reasonable depth of cognition to inform their decisions.
The key to becoming a good dr. is to proceeds the confidence not to need back up when capable of conveying out a job or making a decision and to inquire for help and support when not capable. Remember, the clinical flick is more important in most circumstances than the laboratory results. Look at the patient, not the numbers.
A good doctor also needs to be a squad player. Nurses and those in professions allied to medicine can brand your life easier or harder. Virtually house officers and senior house officers have express applied noesis of the specialties, whereas nurses often have many years of experience—use this to your reward. You will not lose your authorization by asking for their help but will proceeds nurses' respect for realising your limits. Nurses often know consultants quite well and can tell y'all what information they like bachelor on their ward rounds and when they would favour beingness asked for help and advice.
Remember, most nurses don't envy your responsibilities but practice wish to have their concerns heard and answered. We don't heed our advice being overturned. We just want to know yous have registered our concerns, have thought almost them, and weighed the pros and cons of action or inaction.
Finally, and often hardest to reach, is skillful communication with patients. Listen to them, and try to be empathetic. The ultimate responsibility for health decisions is theirs. Remember this. Policies and procedures can be bent to adjust the patient, merely remember to certificate that information technology was the patient's request.
Information technology looks and then simple written down like this, but near doctors still find these attributes difficult to acquire.
2002 Sep 28; 325 (7366) : 711.
A patient speaks
Editor—For several years I was registered with a wonderful full general practitioner in my home town. I never appreciated him until I moved away to study at university.
I went from existence an empowered private to a patient number. There was no recognition that I had existed before I joined my new practice—the staff never referred to any of my previous doctor's notes. It was upsetting to sit across the desk-bound from the general practitioner, give an account of what had happened, and and so observe out that the salient points had not been recorded in my notes. My suggestions for what might be happening were treated with, I felt, derision. After all, what would I know—I'm a mere patient.
It got to the signal where I would come across my general practitioner only if I had a fair thought of what was going on. If I were concerned or worried I'd render dwelling house and run across my "real" full general practitioner equally a temporary resident. So why was one full general practitioner wonderful and the other not?
My real full general practitioner became my practiced all-time friend. He took an interest in me as a person and not as a set up of symptoms. He knew when to speak and, more than importantly, when to shut up. My history was my history, non his questions with his answers. I felt empowered and never bullied into taking a form of action that I didn't want to follow. He seemed to realise that I might be improve placed to make suggestions about what was going on. My experiences lead me to brand the following as a summary of a skilful consultation.
The doctor asks questions; patients give answers. The dr. uses his or her knowledge and skills to help patients make sense of their answers; patients ultimately make up one's mind what they want to do with their doc's support. My unhappiness arose when the medico filled in her own answers.
2002 Sep 28; 325 (7366) : 711.
Eulogy for a good doctor
Editor—In June this twelvemonth I went to the memorial service for an exceptionally good md, Phyllis Mortimer. I had been both a colleague and a patient of hers some years ago. An inimitable woman (one of three women in her year of 150 medical students), she had graduated despite having polio as an undergraduate and myriad wellness problems that connected all her life.
Perhaps this explained something of the compassion she had for her patients and her sheer humanity. Jungians speak of the concept of the wounded healer: that clinicians must be aware of their ain woundedness and then patients can find the health in themselves. The relationship between the two of them becomes in itself a artistic medium unique to that encounter. The protocol is a necessary, merely enormously limited, tool, which provides merely the beginnings of good care. Real evidence based practice is fluid, always changing and continually revisable specific knowledge. Some of the necessary cognition is that which is created in the consulting room itself.
My hubby and I had handling for subfertility for about five years with several clinicians. Phyllis cared for me through many months of it. With her, dissimilar others, the unpleasant procedure was no more than invasive than if she were looking in my ear. This was due to her gentle physical handling of me (despite her own handicap with manus and arm) but specially considering of her interpersonal skills, which were nothing short of extraordinary. She was besides the only clinician nosotros encountered who was able to piece of work (and work well) with the continual disappointment of handling failure. As her colleague (at the time I was the regional lead for quality improvement), I knew of Phyllis'southward reputation for searching to extend the technical quality of care and too of her gifts as writer, dramatist, and manager. Phyllis besides had her flaws. But it was her capacity for equality and sensitivity of relationship—and at the same time holding her professional boundaries and standards—that made her such an exceptionally skillful doctor.
She relished the take a chance to observe creative ways of communicating just besides with the patient from a severely deprived background equally with the educated patient. Phyllis'due south consultations were of a dramatically higher standard than most I have witnessed over the years and uniquely tailored to the patient in forepart of her.
There is no such thing every bit the perfect doctor. The good doc is not one blazon or 1 matter. He or she is "good enough" in the Winnicottian sense—someone who is truly mindful of her or his own limitations and the profession'south limitations. The good doctor has a high tolerance for "not knowing"—an ability to suspend judgment and work with situations of high intractability. He or she is always searching for, moving towards, and finding artistic solutions in the moment at hand, able to agree both promise and failure simultaneously, being different things to dissimilar patients and thereby meeting myriad needs.
Can you lot imagine a world where more clinicians, like Phyllis, were able to transform their inherent handicaps into increased effectiveness? That would mean powerful medicine indeed.
2002 Sep 28; 325 (7366) : 711.
Now I am retired . . .
Editor—What is a skillful md? How practice we make ane? Now I am retired I know how to be a good doc. I know how to listen to a patient. I know how to put myself at the patient's disposal. Put downward your pen. Turn abroad from your desk. Face up the patient. Sit back. Give him or her your total attention. Only thus volition you fully understand the problem.
Before I took upward medicine I knew what made a adept dr.. I was a mature student. Furthermore, I had had extensive experience of being a patient. I had often had blood taken through an quondam fashioned, reusable needle, had had barium meals, sigmoidoscopies, nasogastric feeding, intravenous drips, and more than one operation nether general anaesthesia. I knew what a good physician and a good nurse were similar.
In one case I was qualified things were rather different. Although I was however full of youthful idealism, I became less inclined to sit and listen. I seldom had the chance to sit at all. Still, I loved the work, and, on the whole, I loved the patients. I still felt pity and beau feeling for them. But as time went by, things changed. For one thing I was perpetually aware of fourth dimension's winged chariot hurrying near and well-nigh of the time it seemed to be accompanied by the hound of sky.
Although I had studied art, literature, and philosophy, although I had the gift of tongues and of clear thinking, if not of clairvoyance, I found that the benison of charity, of the milk of human kindness, was leaking out of my soul, squeezed out by the pressures of work, of financial anxiety, of a wife and five children to care for and continue happy, of nights broken past the cries of my own children or the urgent clinical needs of others, of committee piece of work and authoritative responsibilities. I became less patient with my patients, less tolerant of the foibles of the human race, less willing to listen, less able to care.
Once I retired, notwithstanding, things changed again. Of a sudden my financial worries were over. I had savings instead of debts. Well-nigh of my children had left the nest. I had time once again. Doing locum consultant work here and at that place when I felt inclined had all the pleasures and petty of the pain of full fourth dimension consultant work. No committee meetings, virtually no administrative duties. Just ward rounds, outpatient clinics, instruction, and on-telephone call duties every three or four nights. The outpatient clinics were mostly less heavily booked than I had been used to. I could sit back and listen to patients and their parents, could put myself entirely at their disposal. It made a tremendous departure.
If I had my time once again, would I do it any differently? I'one thousand non sure. I promise I would worry less. I hope I would be more than patient, with the patients and with myself. Only present it would exist all unlike. Whereas in my first preregistration chore I was on telephone call for 108 hours a week, present I might at worst be on for eighty hours. In all my 30 years from qualification to retirement, except when I was in the United States, I was e'er on a one in two rota. Nowadays as a consultant, I would be on a one in four rota at worst. Would that make information technology easier to beloved one's patients? I sincerely hope so.
2002 Sep 28; 325 (7366) : 711.
Teach medical students reality to make good doctors
Editor—To make a good doctor we demand medical schools to be honest with students and teach them about how things actually are. We need to provide medical students with that most powerful and unsafe of life forces—reality.
Some patients can be difficult and dangerous. Most clinical decisions have no testify base. Pursuing ethical aspects of each instance is an activity that needs prohibitively intense resource. Doubt looms over all of medicine, and y'all must be able to cope with the pain and guilt that it brings.
We teach students about a cosy, idealised medical environment that really exists in the minds of the academics. When students feel the existent world they do non see the majority of doctors spending a vast amount of time discussing ethics with patients. They observe the show base of operations to be sorely deficient. They soon realise that many serious illnesses tin can present with minimal signs and symptoms, and they must somehow devise a personal way of coping with the hurting and guilt that this uncertainty produces.
I believe that we harm our medical students by non being honest about the real medical environs in which they volition eventually practise. We need to give them the skills to assist them brand their patients healthy but we also need to give them the skills to help them remain healthy themselves. Placing students in a real medical surroundings with deficient skills simply confuses and alienates them and ends up dissentious everyone. If we want to make proficient doctors and then nosotros must teach them in the real earth.
2002 Sep 28; 325 (7366) : 711.
How not to do information technology
Editor—First of all, take "raw" medical graduates and place them in a busy medical unit of measurement. Write a job description that details their rest periods only not their role, their tasks simply not their contribution. Make them work with an ever changing multifariousness of senior colleagues—not for them an old fashioned apprenticeship. Ensure that they never encounter the same patient twice because compliance with hours is more important than the insights they gain from providing continuity of care.
As they move into specialist grooming, crave them to collect and collate precise details of everything except the quality of doctoring they are learning to provide. Teach them that they too tin can profit from the drug manufacture through its necessary supplementation of study leave budgets. Make sure that resources in your institution go where they are actually needed—the only figurer doctors need is between their ears.
When the time comes for inquiry, use this opportunity to reinforce the importance of numerous competing regulatory frameworks in providing the bureaucratic framework essential to employment in NHS management and its support industries, and to deforestation.
As with all healthcare providers, ensure that their bacon, one time trained, is sufficiently modest to concenter but those who are (or should be) committed.
When issues of professional practise ascend, information technology is better to get someone who isn't involved in providing health care to accept it on—they aren't constrained by their understanding of the arrangement they have been asked to modify, and the organisation will cope with all the rogue recommendations—we always have.
The key principle underlying this arroyo is attention to detail. If we collect all information available, write detailed job plans, and provide coherent written justifications for everything, and so all will exist well. Practiced doctoring is nothing more the sum of these private parts, and those who argue that there is some higher value system, some "professionalism" which should be involved, vest in the past. Count everything and value zero.
Not.
2002 Sep 28; 325 (7366) : 711.
Summary of responses
Editor—Altogether 102 people wrote in response to our questions "what makes a good doctor?" and "how can we make i?"14-1 They were clearer on the get-go question than the second, list more seventy qualities a proficient dr. should have. Amid the usual—compassion, understanding, empathy, honesty, competence, commitment, humanity—were the less anticipated: backbone, inventiveness, a sense of justice, respect, optimism, grace.
Responses came in from 24 countries all over the world, and near all of the respondents had something different to say, indicating, as i respondent put it, that "a expert md will exist dissimilar things to dissimilar people at different times." For some, the notion was very elementary: a doctor who satisfies his or her patients; a doctor you lot would trust yourself; a doc who likes people and likes the job; even "a doc who feels for himself the sorrow of human kind."
For others, information technology was more difficult. Like describing a good auto, a proficient play, or proficient weather it all depends on your perspective. A member of the library faculty at a New York academy described a skilful doctor as one who "reads and reads and reads." A professor of bioethics (with an interest in medical history) argued that proficient doctors are also good historians, adding that medical history should take up at to the lowest degree a quarter of the undergraduate curriculum. Educators gave a loftier priority to existence a good instructor, coach, and mentor. And a quality improvement specialist thought a skilful medico was one who critically examined what he or she did and tried to improve on it.
Patients, all the same, wanted little more than a doctor who listened to them.
From this great diverseness a few common themes emerged.
Firstly, in that location are enough of good doctors around and nosotros should nurture them improve.
Secondly, to exist a good medico, y'all first have to exist a expert human being being: "a proficient spouse, a proficient colleague, a good customer at the supermarket, a good commuter on the road."
Thirdly, it'south easier to be a practiced doctor if you similar people and genuinely want to assist them. A general practitioner from Wolverhampton wrote: "To like other people, from this all else follows. Liking your patients will get you through the grind and tedium of your working day, and patient contact will exist a source of strength and renewal. You may even do some good."
Finally, good doctors, unlike good engineers, good accountants, or skilful firemen, are not just improve than average at their job. They are special in some other mode as well. Extra dedicated, extra humane, or actress selfless. More than traditional contributors wanted doctors to sacrifice themselves for the good of their patients. Others said doctors must look after themselves first—or they wouldn't be able to help anyone. Doctors are patients as well.
Few respondents had anything to say about what makes a good doctor in specialties with little patient contact. Pathology, for example, or epidemiology. There wasn't much either on what makes a expert surgeon. One of only 8 contributing surgeons (a urologist from Saudi Arabia) wrote that skilful surgeons are "good doctors with extras." Some other surgeon said that information technology was important for doctors to observe medicine fun, fascinating, and stimulating.
Making a good doctor seemed a greater challenge than defining one. There was general agreement, though, that we aren't very proficient at information technology. To paraphrase thirteen responses: all we can hope to exercise is select students with the right gifts (non the correct exam results) and somehow stop them from going rotten through overload cynicism and fail during their training and early career.
1 outset year intern from Israel echoed several others when she suggested bad societies were unlikely to produce good doctors: "Whilst doctors are overworked, underpaid, and abused, the debate on defining a good doctor will remain bookish," she wrote. "Our society undervalues doctors yet expects and will accept nothing short of perfection . . . Even with perfect risk management mistakes will exist 'made' . . . people will die young or refuse with age, and not all pregnancies will accept a skillful outcome. Unfortunately doctors are more easily sued than God, and moreover . . . pay cash."
References
Articles from The BMJ are provided here courtesy of BMJ Publishing Group
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1124230/
Postar um comentário for "Here She Comes Again Like Good Medicin"