What's a good doctor and how do you make one?

I had a surgeon. He was a lovely man;welcoming,interested and
chatty.But when things went wrong I discovered he was also lazy,
autocratic,dismissing my reasonable request out of hand, and not entirely
honest. The result was a year of anxiety and pain.

I had a surgeon. She was brusque,almost rude, greeting me with ' I
can't do anything about your walking, if that's what you want'. She was
short on small talk, but she was honest, a careful operator and listened
to my opinion, slightly modifying the post-operative routine as a result.

If your problem is a minor one, as is the case for the majority of
patients,then Mr A would serve your purpose admirably. For my part I am
prepared to forego the 'bedside manner' for the old fashioned virtues of
concern and competence. They put me back on my feet.

Doctors should listen carefully enough in order to hear the meanings,
interpretations, and understandings that give shape to the worlds of the
patients. Through the interview, the doctors can unravel complicated
relationships between environment and patients. The good interview
techniques can allow the doctors as researchers to learn how present
illness experiences resulted from past life history of the patients.

During the interviews, the patients are given some power to control
the interview. For example, the power decides what to tell and what to
talk about. Therefore, an in-depth qualitative interviewing creates the
stories for patients. Stories can communicate a moral concern, a message
or a set of core beliefs. These stories may be repeated so often that they
become shared myths of a particular group of patients (e.g., age, class,
educational background and types of illnesses). Those myths can specially
be useful to the doctors who are exploring a cultural arena because myths
can summarize the underlying values of the patients.

Thus, learning to listen will help the doctors to interpret the world
around the patients by developing shared understandings and to learn
collectively how to interpret and behave in specific life circumstances
(Anderson & Jack, 1991).

Reference
Anderson, K. & Jack, D. (1991). Learning to Listen: Interview
techniques and Analyses. In: Women's Words: The Feminist Practice of Oral
History, Eds. Sherna Berger Gluck and Daphne Patai, Routledge: New York,
pp. 11-26.

Dear Sir,

Was it by accident or design that the cover of the current number of the
BMJ - the pictures of 31 people - contains three people from television,
many from hospital specialties, but the Only GP is Harold Shipman?

Yours sincerely,

Irvine Loudon

A good doctor should have the ability to conceptualize and implement
beyond the medical model. A good doctor should have the ability to view
the presenting problems from multiple perspectives.

For example, when a patient with anorexia nervosa comes to see a
doctor, the doctor should not only focus on the issues of eating, body
weight, body image and complications of self-starvation. Rather the doctor
should understand the meanings of food refusal in relation to the
patient's psychological issues such as obsessive-compulsive behaviors and
depressive symptoms; the patient's social context such as the gender
roles, peer influences and effects from mass media; the patient's family
context such as parent-child relationships and family communication
patterns.

The patient and the social environment are interdependent. The doctor
can only have a comprehensive assessment for the patient with an
ecological perspective on health and illness. To conclude, a good doctor
should be ready to challenge his / her own taken-for-granted understanding
of the medical knowledge and to acquire knowledge from other disciplines
such as sociology, psychology, social work, nursing, environment science,
communication studies and others.