Monday, June 18, 2007

What makes a good doctor?

About 25 years ago, when Dr. Lou Wasserman was a young member of the Medical Staff, I was a young manager at CGH. Sometimes I would sit at the cafeteria table with Dr. Jack Prior, who was then the Chair of Pathology. Doctors would join Dr. Prior’s noontime table for clever conversation and talk of difficult cases. When the young Dr. Wasserman sat at the table one day, Dr. Prior asked him, “What did you make of such-and-such a case?” Dr. Wasserman was effusive with facts, observations, and conclusions. For a few minutes the two of them were in a world of their own, discussing the case.

On another occasion, I was in a meeting with Dr. Martin Black, who was at the time CGH’s Vice President of Medical Affairs. Dr. Black was a cardiologist, like Dr. Wasserman. Dr. Wasserman knocked on the door and interrupted our meeting with a quick question. Had Dr. Black, he wanted to know, had a chance to review the EKG tracing that he, Dr. Wasserman, left for him? “I’ll get back to you later today,” Dr. Black said and, after Dr. Wasserman left the room, he winked at me.

Dr. Black lifted from his desk the EKG that Dr. Wasserman had mentioned. It was clipped to a reprint of a medical journal article. “Dr. Wasserman doesn’t know it,” Dr. Black said with mischief in his eye, “but I wrote a paper on this exact EKG abnormality years ago.” Dr. Wasserman had left the EKG strip to challenge Dr. Black, the senior doctor, in identifying an interesting problem. Dr. Black was gleefully planning to one-up Dr. Wasserman by giving him the medical paper he had written on the subject.

As a lay person, I was impressed by the conversations Dr. Wasserman held with Dr. Black and with Dr. Prior. His interest in medicine was earnest, and it was obvious that the more senior members of the Medical Staff appreciated his enthusiasm.

Today Dr. Wasserman is President of the Medical Staff, and he recently addressed the Quality Committee of the Board of Directors. “What makes a good doctor?” he asked rhetorically, then he answered the question by reading from a short piece he had written. Dr. Wasserman listed 22 attributes of “a good doctor.”[1]

“A good physician talks to the patient and not at the patient,” he said, and, “A good physician searches at all times for new clues to confirm or refute an initial clinical diagnosis.” Dr. Wasserman continued, “A good physician performs specific tests to achieve specific goals (avoiding a shotgun approach…).”

“A good physician is an educator,” he said. “No one can know it all in medicine,” Dr. Wasserman observed. “A good doctor learns by study, and also by observing and learning from his or her peers.”

Dr. Wasserman’s short essay put into words the intellectual eagerness and honesty I had observed decades earlier. It is a thoughtful thing to do, to reflect on your own profession and to list the things that make you and others better at your daily work.

I asked Dr. Wasserman to share his “good doctor” list with the members of the Medical Executive Committee, and he did so at its next meeting. After that meeting, Dr. David Halleran told me that Dr. Wasserman’s thoughts reminded him of a new book by Dr. Jerome Groopman, How Doctors Think. He said the book discusses “how to avoid certain mental errors a doctor can make.”

Dr. Groopman is a Harvard University professor and researcher.[2] It is essential, Dr. Groopman writes, “for even the most astute doctor to doubt his thinking, to repeatedly factor into the analysis the possibility that he is wrong.”[3]

In his work Dr. Groopman recounts clinical cases where it took a long time, and sometimes required several different physicians, to make a correct diagnosis. He writes about thinking errors that doctors – or indeed, anyone – can make. It is only by being aware of the possibility of such errors that one can take steps to prevent them or discover and correct them if they have occurred.

Doctors are always reading, learning, attending lectures and classes. They practice new skills, and they help each other learn skills by proctoring one another. But the thing that strikes me about Dr. Wasserman’s thoughts and about Dr. Groopman’s book is their self-awareness. Knowledge is not always about things outside oneself. There is also knowledge of how one thinks and works. This self-knowledge can help one do a better job. It can help avoid falling into inadvertent error.

Years ago when he challenged Dr. Black to identify the abnormal EKG strip, Dr. Wasserman was keeping his thinking skills at a high level. A few weeks ago, when he sat with a yellow pad and reflected upon what it means to be a good doctor, he was keeping his practice skills at a high level.

“These are just some of my thoughts regarding the qualities of a good physician,” Dr. Wasserman told the Medical Executive Committee at the end of his brief essay. “If everyone applies these principles, Community General Hospital, and all out practices and patients will benefit.”

[1] Dr. Wasserman wrote to me: “I actually wrote this ‘What makes a Good Doctor’ document after Dr. [Thomas] LaClair [Chair of Family Medicine] and myself had a discussion regarding what he and I could communicate to the FP (Family Practice) residents regarding the qualities of a good physician.”
[2] Dr. Groopman holds the Dina and Raphael Recanati Chair of Medicine at Harvard Medical School and is chief of experimental medicine at Beth Israel Deaconess Medical Center, Boston.
[3]] Groopman, p. 9


Anonymous said...

Great post! Beautifully put. It always warms me to see doctors (or even people) who really care about things beyond the surface level. I hope that more doctors are or will be like this.

Anonymous said...

Especially in this economic climate, I feel that doctors are bombarded by many unnecessary players in the healthcare industry (insurances, lobbyists, pharm co., etc.) in what defines a "good doctor." This compromises the physician/patient relationship and the ultimate goal of providing healthcare. Great article.