Monday, June 2, 2014

What Are the Characteristics of a Good Primary Care Physician?


PCPs like people. This was true of them long before they started medical school and it will have only blossomed further during training. Ask PCPs, as I have with in-depth interviews, and they will tell you that certain types of individuals are drawn to primary care careers; they have common characteristics. They like to converse with people. They enjoy getting to know about a person – their ideals, their goals in life, their ambitions, their cares and sorrows. They are interested in learning from the patient rather than talking down to the patient; their ego can be strong but not as to impose themselves on the patient. They tend to not only want to know their patient but also to understand his or her place in their family and society. He or she is a person who wants to know the “whole story;” they tend to see the patient as a whole person, as part of a family and part of a community. They see the patient as a unique individual and his illness as part of that totality of the person, not just a diseased organ or system. To paraphrase Sir William Osler, a good doctor tends to the person who has a disease rather than just the disease itself.   
PCPs generally like to engage in an intellectual puzzle, a mystery to solve.  They have a “general contractor” mentality meaning that they see themselves as capable of getting much or even most of the job done themselves but are comfortable in drawing in others as necessary and in so doing are committed to coordinating everyone involved in the patient’s care. As with all of us, they wish to earn a good income but money is not the most important thing in their life nor is it what drove them to become physicians.
What are the characteristics of a good physician? The deputy dean for education at Yale Medical School, Richard Belitsky, M.D., talked to the freshman class a few years ago at their White Coat Ceremony about becoming a doctor. Greatly abbreviated, he told them there was much to learn “but so much of what you need to be really good doctors, you already know… Becoming a great doctor begins not with what you know, but who you are. Being someone’s doctor is about a relationship. That relationship is built on trust…Being a great doctor begins not with what you have to say, but your ability to listen.” 
In my interviews, primary care physicians report that listening is the key and most important attribute of being a good physician in primary care. By listening they mean one who listens to the patient’s story without rushing it and without embellishing it. They let the patient develop his or her own story of their situation perhaps with some prompts to help them focus but without unduly narrowing the narrative. The PCP must at the same time be nonjudgmental if he or she is to learn from the patient and develop a strong doctor patient relationship – the third major attribute.  PCPs need to like people and thus like their patients.  The good PCP is well grounded in basic medical science, the latest in evidence-based care and is constantly seeking continuing education. The good PCP is conservative, meaning that he or she will work with lifestyle, behaviors and other measures such as nutrition or exercise before resorting to drugs or procedures. This requires patience; not everything can be “fixed” immediately. They feel that knowing the patient over the long term aids the care process and enhances the doctor patient relationship as does being attuned no only to the physical needs but also the patient’s emotional and spiritual requirements. Knowing the patient’s family not only helps to understand the patient but they will be the physician’s ally if and when needed later. It is important to attend to the patient in the same manner that one would want to be treated by others. Combined, these will develop trust, respect and partnership. Some will not only be very good physicians but also true healers, a desired state that only some attain.
A physician who saw this post previously commented that I forgot two things – leaping tall buildings in a single bound and being a good typist. The problem of course is that PCPs today do not have enough time with their patients so even if they possess all or most of these characteristics they are trapped in a business model that does not value time.
When a general audience on LinkedIn was asked by Paula Stanziani what in one word constitutes a good doctor the answers varied of course but some of the most noted common attributes are these: Listener, commitment, compassion, humanity, attentive, patient, competent, teacher, healer and ethical. A good overview from one respondent, Scot Sturtevant, was “I’ve met many a physician in 36 years of service. Some brilliant, some not so much. The one thing I have noticed though those that were great, truly great, were those who were humble, but confident. They would listen quietly to a patient's story, and were never really rushed nor found themselves panicking in a critical situation. They were stoic yet responsive, and treated nurses, technicians and even field medics as a valued part of the team. To sum it they know who they are, and where they came from... And like all of us, still put their trousers on one leg at a time. There really isn’t a single word to describe greatness, it’s part of the diverse nature of who they are and how they apply what they've learned and what they know.”
That sums it up well for me.
Next post: The frustrations of being a primary care physician.
 

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