Bullsh*t. Or, What Really Makes A Good Doctor.

Special K and I have been hard core study buddies since first year. She is one of the hardest working, most down to Earth, big-hearted individuals I have ever been lucky enough to know. A few weeks ago we got together for one last session before taking our school’s Dreaded OSCE. During one of our requisite chat (gossip) breaks we started talking about tests, grades, and the Imminent Future. As we were talking I noticed a change in her demeanor. Her face fell, her shoulders slumped and her eyes fixed on her hands nervously twisting in her lap. “So and so and Yadda yadda’s grades are so much better than mine,” she finally said dejectedly and sighed, “I know they are going to be better doctors than me.”

I was gobsmacked. Uhhhhhhhhhhh that’s Bullsh*t, I replied.

Do you really think getting the best grades makes a person The Best, or even a “Good” doctor? I asked. Really?? Because I have talked to a lot of patients over the years about a lot of doctors and when people have told me how great their doctor is or how much they like them, they have never once been been referring to anybody’s grades or test scores.

And why would they be?

The fact is, anyone who makes it through four years of medical school and a residency has to have at least a modicum of brain function. But it doesn’t exactly take genius (obviously, they keep letting me go). Honestly, a chimpanzee with more than average mind power, manual dexterity, and determination could probably stop throwing feces long enough to click on a link for UptoDate and formulate a reasonable treatment plan for most clinic patients. Shocking, but true.

I’m not saying that some serious intelligence doesn’t come in handy in medical school. Naturally, we have quite a few freakishly smart individuals in my class and I have often looked on wistfully (enviously, resentfully?) as they blissfully napped through lectures, if they showed up all, only to subsequently, effortlessly ace every exam. As (slightly) less intellectually gifted individuals like Special K and I studied day and night, chasing PPI’s and NSAIDs with gallons of caffeinated beverages, sweating, laboring and praying through each potentially career-destroying multiple choice marathon, just hoping to make it to the next round. (Though I will say, whatever we may lack in IQ points we more than compensate for with sheer mule-headed stubbornness and blind determination. Okay, maybe that’s just me with the stubbornness.)

I’m not saying astronomical levels of cleverness aren’t helpful for a practicing physician either. How great would it be to have a mental Wikipedia wealth of information with Google-like instant recall? To not have to mar the silhouette of your spiffy white coat by stuffing the pockets with essential clinical references or spend more time with your PDA than your significant other because you constantly have to look crap up? Seriously, how great would that be? Because I wouldn’t know.

Which leads me to one of the doctor traits I’ve heard patients most commonly praise. Patients appreciate it when doctors admit that they don’t know stuff. Even though they come to us for our expertise, with expectations of benefitting from our superior knowledge, they know we are not infallible and welcome a show of humility, humanity and honesty when we are in over our heads. Of course it also helps when we then bust our butts to figure it out or to find someone else who can.

Which shows that we really, truly care. One of the top two patient responses to the informal “What really makes a Good Doctor?” survey I conducted after my conversation with Special K. Patients like, value, and trust doctors who sincerely care about them. And intuitively so. Because if someone really cares about you, they are going to do their d*mndest to help you.

One of the ways doctors can most effectively show that they care is the second most common response I heard in my informal investigation into quality doctoring. Patients like it when doctors listen to them. It simultaneously makes perfect, and no sense at all. They come to us for our knowledge, to receive the benefit of all information we’ve spent years internalizing, and expect us to spend our time listening to them. Because patients know, that if we don’t really listen, and appreciate what they have to say about what’s wrong with them, all of our hard-won (for some of us anyway) knowledge is completely useless.

And there you have it. What really makes a Good Doctor. A Good Doctor listens to their patients. Because they care and truly want to help. Because in order to effectively use all the information (or medical references) they’ve spent years accumulating, they always, first and foremost, have to engender the trust of their charge. To get the patient to open up and share their story. To listen and learn from the most important instructors we will ever have, which is the only test that ultimately matters. I think anyone who remembers this is going to be a Good Doctor.

Take that Biochem.

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