The Most Important Qualities for the Good Doctor

Recently, on ward internal medicine inpatient rounds, one of us asked the residents and students what they considered to be the most important quality in a good doctor. Not surprisingly, most of my team members felt that a large and complete fund of knowledge in internal medicine was the most important quality. Why, not surprisingly? The answer is simple. We constantly probe and test our students and residents in order to assess their knowledge of internal medicine and its daily application. The residents were told that this was a reasonable answer, but not the most essential quality in a good doctor. For me (JSA), I explained, that the most important feature of a good doctor was kindness closely allied with empathy. Why is this the most important element in my opinion? Because sheer knowledge alone without a hefty dose of kindness and empathy, major elements of our humanity, will mean that the “kindness- and empathy-deficient” doctor will not be able to understand what the patient is experiencing and will also not be able to forge a strong and caring relationship with that patient.

Of course, empathy and kindness are not the same thing, but we would hope that the so-called “good doctor” would have a healthy dose of both characteristics. Empathy is a mind process whereby the person recognizes the situation of another human being, such as their pain and suffering, and relates to this other person with sympathy. It clearly requires cerebral processing. Kindness is an element of a person’s personality and may have genetic components that determine it in part. However, usually kindness in a person is the result of their upbringing and lessons learned in childhood. We remember clearly our parents admonishing us frequently to be “kind to people and to animals.” In my opinion, the best doctors are those who have a healthy dose of both empathy and kindness stored in their neurons! Empathy and kindness are especially needed when dealing with difficult and challenging patients.

Challenging patients come in many categories. For example, there are those who either claim that no doctor has ever been able to help them or that all doctors are in reality paid servants of the pharmaceutical industry. We are sure that many doctors when faced with such a patient end up terminating the interview as quickly as possible. Sometimes, there is no other option. However, we have observed that the following strategy often helps: First, we acknowledge that the patient is suffering and that perhaps a solution has yet to been found. Then we slowly explain what our understanding of the problem is and how we may be able to find some form of therapy that would help to relieve their suffering. One visit is usually not enough for these challenging patients, but with repeated interactions, some form of therapy often does result in improvement in the patient’s symptoms. During our long clinical careers, we have been faced with a number of these “difficult” individuals who, when managed as described, become devoted and long-term patients. Keep in mind that the doctor must have a large fund of knowledge as a basic commodity before any positive intervention is undertaken. Empathy and kindness alone are not sufficient. However, in order to reach the point where the patient is willing to work with the doctor, one needs to start with a substantial dose of kindness and empathy. So-called difficult or challenging patients often have a history involving painful and even traumatic experiences, and no therapeutic relationship can be established until the patient perceives that the doctor understands the extent of his or her suffering and offers kind and empathetic support.

An interesting question is whether empathy and kindness can be taught. Psychologists have studied whether or not empathy can be learned and the answer is evidently “Yes.”1^,2^,3 These days, US medical curricula do attempt to teach medical students how understanding a patient’s feelings can promote their recovery. In our experience, reassurance often helps patients once the doctor understands what is causing the suffering. One of us remembers telling a spouse that her husband had suffered a myocardial infarction and was recovering nicely. She was tearful and inconsolable until it was disclosed that she thought she had caused her husband’s myocardial infarction by feeding him hot dogs for dinner. Once her pain had been perceived along with the explanation for it, successful reassurance enabled her to understand that the ingestion of hot dogs had not caused her husband’s illness. This reassurance had a very positive effect, and, subsequently, she was able to support her husband very effectively during his post-hospital cardiac rehabilitation. What about kindness, can this too be learned? Evidently, kindness can be learned as well, but much of the research in this area has focused on teaching children how to be kind and compassionate. Nevertheless, an adult can be taught and can learn to practice acts of kindness to the point that this quality becomes part of his or her personality.4^,5 The most common technique is simple and involves a series of acts that can be performed to help develop an internal kindness “app.” Suggestions included simple things such as picking up a piece of trash from the sidewalk and depositing it in a trash can or assisting an elderly person in crossing the street. Other acts are more complex and require more time, for example, accompanying an elderly person to the supermarket to assist with shopping. The articles cited below4^,5 have convinced us that practicing kindness is a form of behavior modification therapy that could result in kindness becoming integrated into a person’s personality.

As always, I enjoy hearing from readers at jalpert@email.arizona.edu or on our blog at amjmed.org.