The Good Doctor Myth

The Good Doctor Myth:
This article may hurt some feelings. I apologize in advance, but this is how I truly feel. Basically for students and patients.

“Just looking at the doctor took away half my pain / illness”
“The doctor always makes me laugh and reassures.. A very nice human being, very compassionate”
“I am very close to the doctor.. he/ she calls me his younger brother / sister etc.”
“He / She is so busy, but still saw me and advised”

It is quite common to hear these sentences in a hospital. It is expected from a doctor that he / she must dress well, speak well, be nice, mannerful and compassionate, and ease out the patient’s worries.

This I agree is essential, but is this all? Would any smiling / laughing pleasant, well dressed and well behaved doctor who takes away your worries by well – chosen words (and a pat on the back) be enough to handle your life?

Think again.

For making a health decision, what all qualities must the qualified doctor have?

1. Exactness of current knowledge and literature about that particular illness.
2. Experience in handling that particular illness and its complications, without
involving ego (Many would just decline counter-opinion just because it came
from a rival / junior etc.)
3. Analytical abilities based upon a combination of the above two.
4. Concentration: possible only when you are not very busy or supermultitasking.
5. A complete knowledge of the patient’s health profile: Detailed history, medical
conditions, ongoing treatments (allopathic and other), ongoing diet, allergies,
other specialists treating the patient, addictions etc.
6. Surgical skills in that particular specialty.
7. A readiness to explain the true nature of illness, its complications, all
treatment options etc., a respect for patient’s choices (not persuading the
patient to make a choice by telling only the worst possibility) , readiness to
accept mistakes and explain the patient about them.

We are in the age of superspecialisation. This means the basic doctor (MBBS) goes through specialisation (MD /MS = 3years) in a specialty, then through Superspecialisation (DM /MCh = 3years), then through fellowships (2-3 years) as a postdoctoral superspecialist. (There are many other true and fake degrees, which again is a debatable topic).

As one climbs higher in a specialty, he /she becomes less and less expert in other fields as they need more concentration upon one subject for many years. One is supposed to refer the patient to another / superior specialist in case of a condition that is not one’s own specialty or beyond experience.

However, many doctors who appear very pleasant to the patient because of the qualities mentioned above, take advantage of the patient’s faith in them, and keep on treating the patient either themselves or through specialists of their choice / liking / etc. (This is what the patients know as ”rackets” in our profession).

This results in:

False reassurance of safety / lifespan in treatable / untreatable medical conditions.
Delay in treatment / incorrect / overtreatment (Stroke / Cancer / Parkinsonism)
Wrong drug / dose choices (most common example: epilepsy).
Complications due to drug interactions / disease worsening/ combinations of these two.
Falsely attributing complications to some pre-existing disease.
Incomplete evaluation / screening before surgery that results in surgical / postsurgical complications.
Accidents due to non-treatment of conditions that may make the patient unconscious.

The “Good Doctor” is the one who, besides being polite, nice, compassionate and understanding, spends time for interacting / talking to the patient, examining him / her in detail, explaining the diagnostic possibilities and need for investigations advised, risks involved, and realistically addressing the patient’s fears in a kind manner. The good doctor will also answer all questions that the patient has about this consult / diagnosis, and offer all possible options of treatment. He / she will also freely mention the dilemmas in diagnosis (instead of “impressing the patient” by pretending to understand and answer everything) and also the problems he/she could not solve, and suggest references to other colleagues / specialists for a second opinion.

A good surgeon will talk to the patient after surgery, mention his / her associates / assistants who helped during the surgery, and explain good and bad outcomes boldly, thus gaining patient’s confidence in truth.

Gone are the days of a smiling / laughing “I-know-it-all-don’t-you-care” pseudoreassuring doctor who would definitely uplift a patient’s mood, but certainly cause harm by mis/delayed diagnosis. Also gone are the days when patients should accept a “quick” consult in a hurry by a very busy doctor continuously attending phone, handling a hundred things simultaneously etc… A decision for treatment, and especially surgical intervention must always come from a calm and concentrated mind.

The patient must also know that if a doctor is to spend more time with you, he/ she will have to see less patients, so the consulting fees may increase as per time / skill. Patients should concentrate upon what is being told, avoiding repetition of the same questions. Google based interview of the specialist should be avoided. One must have complete faith in the qualities, abilities of his / her doctor, unless proven otherwise.

The purpose of this article is to highlight that only external appearances and behaviours do not make a good doctor, as is the general perception especially among the frightened, depressed and illiterate patients.

Wishing best health to all.

Rajas Deshpande

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