Patients' views of the good doctor
BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7366.668 (Published 28 September 2002) Cite this as: BMJ 2002;325:668All rapid responses
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As Coulter mentioned [1], I hope that most doctors are good doctors
in the eyes of most patients. When I graduated from a medical school 30
years ago, one of the professors said to us, "You don't have to become a
great doctor. Be a good doctor." According to his definition, a great
doctor is one who can cure the incurable and a good doctor is one who can
treat a curable patient.
He also told us not to become a bad doctor at
least. A bad doctor is one who does something wrong to patients. To my
regret, smoking prevalence among Japanese physicians is much higher than
British or American physicians [2]. Smoking doctors play a bad role model
not only for patients but also for the general public. Efforts should be
made to decrease smoking doctors and to become the nonsmoking policy a
norm among medical professions in Japan.
References
[1]Coulter A. Patients' view of the good doctor. BMJ 2002;325:668. (28
Sept.)
[2]Kawane H. Smoking among Japanese physicians. JAMA 2001;286:917.
Competing interests: No competing interests
Satisfaction is based on expectation. Angela Coutter challenges the
idea that patients put continuity of care at the top of their wish list.
Most of us grew up with an belief that the same doctor reviewing a patient
results in the best care for that patient. We think our patients agree. We
expect them to want to see the same doctor regularly. However, in
countries where the system is different, expectaions are also changed. In
Australia, where junior doctors are restricted to 76 hours per fortnight,
there are large numbers of junior doctors, mainly working shifts. It has
been this way for several years. Patients show no preference to see the
same doctor every day, so long as the doctor they do see appears to know
what is going on and can communicate that to the patient.
With the inevitability of a shorter working week for doctors, twice or
thrice daily handovers will become the norm. We must let go of our
prejudice that sees continuity of care as a central tenet of our prctice.
Instead, we must learn to communicate better, both with each other (at
handover) and our patients.
Competing interests: No competing interests
For patients' sake! Leave doctors alone!
EDITOR- A Nobel Prize winner and a saint. Nothing less is what both,
patients and colleagues, would agree a perfect doctor is.
From a realistic standpoint, all we can do is trying to turn a
sufficient number of those more gifted and committed into reasonably good
doctors, able to meet reasonably well the public demands and then the most
important comes: we must grant they are allowed to perform their work.
From time immemorial, ill people have believed in the powers or
skills of others to heal. The supposed capacity of doctors to cure has
long time depended almost exclusively on their talent to make their
patients rely on it, so that they felt relieved and hopeful during the
natural course and outcome of their diseases, which seldom if ever could
be modified for good, and then, only slightly(1). Since modern technical
advances succeed to solve but a part of the vast catalogue of human
pathologies and not in all instances, patient's trust is still important
in medical practice.
Over millennia, this plain but delicate art has granted doctors high
steps in social esteem. But these are not unfair tributes physicians had
imposed upon their fellow citizens by mastering their fears, rather on the
contrary, they are something heartily rendered because of the patients'
need of considering them highly in order to rely and feel safe, for
prestige is an indispensable tool in every doctor's briefcase.
It is not surprising whatsoever that, despite journalists' and
antipaternalists' fixations and harassment, doctors maintain in a great
deal their social authority and good reputation(2). All throughout the BMJ
issue on the subject, one can read once and again about the patients'
statements of their want for humane and competent doctors who listen at
them, i.e.: that old fashioned somebody on whom rely when facing up pain,
disease and death. Taking doctors down a peg, which many would-be
progressives think to be so good, can only be detrimental.
But if politicians, journalists and others have failed to kill the
relationship between doctors and patients, they do have succeeded greatly
to poison it. Being ill people easily manipulable, doctors and medicine
are easy targets for any demagogue.
Objective goodness that goes unnoticed or is misunderstood will
hardly exert all its beneficial effects, and the accurate perception of
quality is not such innate and widespread an ability as could be supposed.
The well known history of an experiment conducted by a wine expert whose
comments drew the audience to rate a remarkable wine lower than a
deplorable plonk is a good example.
Paradoxically, it is now, when modern medicine has become as
effective and trustworthy a craft as never before, that suspicion and
hostility set up in society and doctors feel their pedestals to stagger,
being tempted to resort to the woeful defensive medicine, for confidence
of doctors in the patients is as much a prerequisite for good practice as
confidence of the patients in doctors is for a satisfactory therapy.
Little change can be expected from lawyers, compensation seekers or
those campaigning for miscellaneous and outlandish rights and resentments.
Journalists must know there are plenty of other profitable fields to
spread dirt on to draw notoriety without causing so much social harm.
Politicians should learn there is a difference between making health
policy and thriving in politics at the expense of public health, and
realize that promising nonsense and setting patients against doctors can
only make medical care more expensive and unsatisfactory, which does not
yield votes.
That patients and doctors can trust each other is essential for an
operative medicine and those challenging this fact should reflect on the
sacred words about scandalizers (Mark 9:42).
REFERENCES
1. Douglas C. Doing better, looking worse. BMJ 2002;325:720
2. Coulter A. Patients' view of the good doctor. BMJ
2002;325:668-9
Competing interests:
The authors are practising health workers.
Competing interests: No competing interests