So what makes a good doctor in the eyes of a patient? It’s complicated and maybe different for everyone. But what is most important in my opinion is that the doctor understands the patients situation and the options available. Then the doctor needs to be able to explain the options effectively including all the pros and cons. And then…hopefully some empathy.
Recently, I had a colonoscopy/endoscopy and was chatting with the anesthesiologist. I said that I usually am more concerned about the capabilities of my physician than I am about any condition that I might have. He was in agreement and gave me recommendations for a cardiologist. It was kind of out of the blue but we were talking about interventionalists as I am retired from a medical device company that made drug eluting stents. The next day I looked the doctor up on the hospital/clinic site and he seemed to have bad reviews from patients. This is not necessarily indicative that he is a bad physician, but it does have some possible implications for his ability to communicate with lay people. Physician to physician he might be excellent, but for me maybe not.
It really is a mine field for anyone choosing a physician. I generally google stalk potential physicians to see where they studied, where they interned and how many years they have been practicing and perhaps articles they have written. I also look at reviews from within the associated clinic system and outside the system. But I still feel it is a gamble. If you don’t have someone on the inside of the system, you are on your own.
My husband and I have had plenty of experience with the medical system. It hasn’t always been easy but at least we don’t hesitate to speak up. I am heartened by these type of questions that come from professionals within the system (Dr. Goodman). I am currently in remission from diffuse large B-cell lymphoma. I have great respect for the roller-coaster ride that my oncologist is on (one patient in remission, next patient has relapsed and finally, another patient needs hospice care). And he is very patient and helpful with all my questions. It is not an easy profession he has chosen but I am glad he is there. The bottom line is my doctor is there to help me make decisions and whatever helps him do that well and effectively, I support.
That hypothesis may be true, but I still think there are many clinician doctors who work plenty hours a year and still don't make the best decisions based on the best available evidence to improve patient related outcomes according to their values.
An alternative hypothesis: May be that those research and institutional positions attract doctors with less vocation to perform a good clinical work?
Maybe I'm wrong, but I still think a doctor who works few hours / days per year but with good common sense and judgment, good literature appraisal skills and which had a lot of patients and experience in its residency and/or early assistant days can still be a very good doctor, maybe better than some who work plenty of hours but lack good judgment and good literature appraisal knowledge and skills.
A good doctor is subjective. A good doctor to me may be a horrible doctor to someone else. So who is the judge, and how doctors being screened for this honor?
My GP knew a little about a lot. He had no problem seeking information from books and articles. He also had no problem saying that what I had required someone who knew more than him. Thus the referral.
At the end of the day I would vote him as a "good" doctor. He was honest and could treat the day to day minutia. I don't have facts or data to back this up, but in the grand scheme of things, don't most patients mostly have minor, easily recognizable and treatable conditions/diseases?
Is any doctor good? Can he heal and make healthier a patient without using excessive testing, procedures and drugs for life? No. The good doctor, while he may adhere to the "standard of care" has the full power and non-liability to murder you.
An analogy to business and engineering profs vs. practitioners. Would I trust a bookish prof to run a business or send a rocket to orbit? Skill means doing things regularly, not once or twice a year!
One may get *better* results from a generalist than a specialist in cases like ALS or advanced cancer. A generalist may be wiling to discuss end of life care more realistically than a sub sub specialist. As a generalist, having watched many patients go to the big city and get super specialized care, only to die in an ICU that requires their family to make an unpleasant, long drive to visit them, I wonder if we're really doing these very sick patients with limited life expectancies any favors by shipping them off.
The lack of research into predictors of "good doctor" has practical implications. My boss tells me that 20 minutes is enough time to do a physical on a healthy 80 year old. I cannot point at anything that says I will get better results if I spend more time.
In many states (maybe all; I don't know), experts witnesses have to spend at least half their time doing direct patient care. Maybe clinical doctors should be in a similar situation. If you spend more than half your time doing non clinical work, you're not a clinician.
From a socio-economic POV I think people work too much - even physicians in countries that have already reduced the basic amount of full-time hours.
The problem of professional deformation is also relevant: as time goes by, people tend to become conservative over their ideas and watch things only from a single POV; this can become dangerous whether you do surgery, research or anything.
Still I think that some skill threshold auditing should be in place.
I have spent my clinical lifetime as a generalist, I would argue that this discussion goes even deeper, to the relative values of subspecialisation vs generalisation, and the way they work together.
As an example, I would argue that every new admission to a general hospital should be under a generalist, with the subspecialists working as consultants until the diagnosis and management plans are settled, and then care transferred appropriately.
Or even more provocatively, every acute psychiatric admission should be under a general physician.
What of people who work part time for caring responsibilities. The mother who works one morning a week in family medicine. It would never be suggested that these people are incompetent. Many people work less than full time-why is it that people in research raise people’s hackles.
Secondly the idea that if you are a specialist but in the absence of a disease modifying drug you can not improve outcome is exceptionally myopic and fails to take into account the many things that may improve a patient’s experience. So much of medicine is decision making and anticipation and using what you have judiciously. A generalist may not appreciate or have access to the multidisciplinary approaches a person who lives and breathes a condition.
Finally - if you can’t even define what your “good” endpoint is then this entire discussion is moot.
Been recognised in surgery for eons that Professors who come from an academic background are lousy surgeons. On the other hand Professors appointed on clinical merit have often published relevant working practice literature that's useful in clinical care, and not Pharma funded.
Do you want your skull base brain tumor taken out by a neurosurgeon who does only skull base tumors, or by someone who mixes cranial and spine? You do not.
Primary take away: "We know very little about what predicts a good doctor, ..."
You can play a guitar everyday and still not be a great guitarist.
Practice does not necessarily make perfect; practice makes permanent.
How much of clinical iatrogenesis (and there is a massive amount and much of which would not be malpractice per se but nonetheless avoidable) is built into the system.
The pilot analogy used by Dr. Goodman seems instinctually correct but is almost certainly wrong. Commercial air travel is massively safe in spite of human pilots. When life is at risk we use redundancies, risk management, and automaton that takes the human OUT of the equation to make things safer.
For good of patients are doctors willing to take themselves out of equation, where it makes sense to do so?
In the late sixties and early seventies, one major teaching hospital in Sydney Australia used these criteria for selecting residents for Physician Training:
1 A reasonable academic record, nothing stellar..
2 Played a team sport
3 Played a musical instrument
Now, to be fair, these were the days when everyone trained first to be a general physician, but these criteria were selecting for someone who good sequential and associative thought skills, who valued collaborative effort.
In the eighties, the College of Surgeons and Physicians in Ontario conducted a study which audited the clinical outcomes of a large sample of all registered doctors, looking at occurrence of major clinical errors. It found the significant predictors for major clinical error were solo practice, not a fellow of a clinical college, and age over 60.
Oh and increasing numbers of air disasters are caused by substituting automation for good piloting, thinking 737-Max forced attitude correction- I'd rather have Capt. Sully at the controls than a hackable computer programmed by a tech nerd.
I learned to fly at the same time I was a surgical resident, struck me then how much more rigorous flight than surgery training was. I worry about current surgical training -DEI selection together with woke indoctrination has led to very few widely competent surgeons IMHO, which is probably why they fall into narrow clinical niches. Shame as I always enjoyed seeing a technique or procedure in one specialty which could be transfected into another.
So what makes a good doctor in the eyes of a patient? It’s complicated and maybe different for everyone. But what is most important in my opinion is that the doctor understands the patients situation and the options available. Then the doctor needs to be able to explain the options effectively including all the pros and cons. And then…hopefully some empathy.
Recently, I had a colonoscopy/endoscopy and was chatting with the anesthesiologist. I said that I usually am more concerned about the capabilities of my physician than I am about any condition that I might have. He was in agreement and gave me recommendations for a cardiologist. It was kind of out of the blue but we were talking about interventionalists as I am retired from a medical device company that made drug eluting stents. The next day I looked the doctor up on the hospital/clinic site and he seemed to have bad reviews from patients. This is not necessarily indicative that he is a bad physician, but it does have some possible implications for his ability to communicate with lay people. Physician to physician he might be excellent, but for me maybe not.
It really is a mine field for anyone choosing a physician. I generally google stalk potential physicians to see where they studied, where they interned and how many years they have been practicing and perhaps articles they have written. I also look at reviews from within the associated clinic system and outside the system. But I still feel it is a gamble. If you don’t have someone on the inside of the system, you are on your own.
My husband and I have had plenty of experience with the medical system. It hasn’t always been easy but at least we don’t hesitate to speak up. I am heartened by these type of questions that come from professionals within the system (Dr. Goodman). I am currently in remission from diffuse large B-cell lymphoma. I have great respect for the roller-coaster ride that my oncologist is on (one patient in remission, next patient has relapsed and finally, another patient needs hospice care). And he is very patient and helpful with all my questions. It is not an easy profession he has chosen but I am glad he is there. The bottom line is my doctor is there to help me make decisions and whatever helps him do that well and effectively, I support.
That hypothesis may be true, but I still think there are many clinician doctors who work plenty hours a year and still don't make the best decisions based on the best available evidence to improve patient related outcomes according to their values.
An alternative hypothesis: May be that those research and institutional positions attract doctors with less vocation to perform a good clinical work?
Maybe I'm wrong, but I still think a doctor who works few hours / days per year but with good common sense and judgment, good literature appraisal skills and which had a lot of patients and experience in its residency and/or early assistant days can still be a very good doctor, maybe better than some who work plenty of hours but lack good judgment and good literature appraisal knowledge and skills.
A good doctor is subjective. A good doctor to me may be a horrible doctor to someone else. So who is the judge, and how doctors being screened for this honor?
My GP knew a little about a lot. He had no problem seeking information from books and articles. He also had no problem saying that what I had required someone who knew more than him. Thus the referral.
At the end of the day I would vote him as a "good" doctor. He was honest and could treat the day to day minutia. I don't have facts or data to back this up, but in the grand scheme of things, don't most patients mostly have minor, easily recognizable and treatable conditions/diseases?
Is any doctor good? Can he heal and make healthier a patient without using excessive testing, procedures and drugs for life? No. The good doctor, while he may adhere to the "standard of care" has the full power and non-liability to murder you.
An analogy to business and engineering profs vs. practitioners. Would I trust a bookish prof to run a business or send a rocket to orbit? Skill means doing things regularly, not once or twice a year!
One may get *better* results from a generalist than a specialist in cases like ALS or advanced cancer. A generalist may be wiling to discuss end of life care more realistically than a sub sub specialist. As a generalist, having watched many patients go to the big city and get super specialized care, only to die in an ICU that requires their family to make an unpleasant, long drive to visit them, I wonder if we're really doing these very sick patients with limited life expectancies any favors by shipping them off.
The lack of research into predictors of "good doctor" has practical implications. My boss tells me that 20 minutes is enough time to do a physical on a healthy 80 year old. I cannot point at anything that says I will get better results if I spend more time.
In many states (maybe all; I don't know), experts witnesses have to spend at least half their time doing direct patient care. Maybe clinical doctors should be in a similar situation. If you spend more than half your time doing non clinical work, you're not a clinician.
From a socio-economic POV I think people work too much - even physicians in countries that have already reduced the basic amount of full-time hours.
The problem of professional deformation is also relevant: as time goes by, people tend to become conservative over their ideas and watch things only from a single POV; this can become dangerous whether you do surgery, research or anything.
Still I think that some skill threshold auditing should be in place.
"I'm tired of jerk tweets that are meant to be divisive." Then get off Twitter. Problem solved.
I have spent my clinical lifetime as a generalist, I would argue that this discussion goes even deeper, to the relative values of subspecialisation vs generalisation, and the way they work together.
As an example, I would argue that every new admission to a general hospital should be under a generalist, with the subspecialists working as consultants until the diagnosis and management plans are settled, and then care transferred appropriately.
Or even more provocatively, every acute psychiatric admission should be under a general physician.
What of people who work part time for caring responsibilities. The mother who works one morning a week in family medicine. It would never be suggested that these people are incompetent. Many people work less than full time-why is it that people in research raise people’s hackles.
Secondly the idea that if you are a specialist but in the absence of a disease modifying drug you can not improve outcome is exceptionally myopic and fails to take into account the many things that may improve a patient’s experience. So much of medicine is decision making and anticipation and using what you have judiciously. A generalist may not appreciate or have access to the multidisciplinary approaches a person who lives and breathes a condition.
Finally - if you can’t even define what your “good” endpoint is then this entire discussion is moot.
Been recognised in surgery for eons that Professors who come from an academic background are lousy surgeons. On the other hand Professors appointed on clinical merit have often published relevant working practice literature that's useful in clinical care, and not Pharma funded.
#2 can be true of surgeons.
Do you want your skull base brain tumor taken out by a neurosurgeon who does only skull base tumors, or by someone who mixes cranial and spine? You do not.
I think that I would choose the sub sub expert surgeon. But, I would want to be admitted by and followed by a GP
about time somebody kicked Musk's six. . . . .given what a blowhard he is
Always blasting somebody about freedom of speech while little girl CEO affirms
Twitter regularly censors.
Primary take away: "We know very little about what predicts a good doctor, ..."
You can play a guitar everyday and still not be a great guitarist.
Practice does not necessarily make perfect; practice makes permanent.
How much of clinical iatrogenesis (and there is a massive amount and much of which would not be malpractice per se but nonetheless avoidable) is built into the system.
The pilot analogy used by Dr. Goodman seems instinctually correct but is almost certainly wrong. Commercial air travel is massively safe in spite of human pilots. When life is at risk we use redundancies, risk management, and automaton that takes the human OUT of the equation to make things safer.
For good of patients are doctors willing to take themselves out of equation, where it makes sense to do so?
In the late sixties and early seventies, one major teaching hospital in Sydney Australia used these criteria for selecting residents for Physician Training:
1 A reasonable academic record, nothing stellar..
2 Played a team sport
3 Played a musical instrument
Now, to be fair, these were the days when everyone trained first to be a general physician, but these criteria were selecting for someone who good sequential and associative thought skills, who valued collaborative effort.
In the eighties, the College of Surgeons and Physicians in Ontario conducted a study which audited the clinical outcomes of a large sample of all registered doctors, looking at occurrence of major clinical errors. It found the significant predictors for major clinical error were solo practice, not a fellow of a clinical college, and age over 60.
Oh and increasing numbers of air disasters are caused by substituting automation for good piloting, thinking 737-Max forced attitude correction- I'd rather have Capt. Sully at the controls than a hackable computer programmed by a tech nerd.
I learned to fly at the same time I was a surgical resident, struck me then how much more rigorous flight than surgery training was. I worry about current surgical training -DEI selection together with woke indoctrination has led to very few widely competent surgeons IMHO, which is probably why they fall into narrow clinical niches. Shame as I always enjoyed seeing a technique or procedure in one specialty which could be transfected into another.