I just read an article in the American Medical Association (AMA) news focused on residency training that identified “8 traits that make great doctors.” The author, Ami DeWaters, MD, explained that when assessing their own competency, resident physicians (probably like most of us) tend to focus on what they don’t know. However, medical knowledge is not all that is needed to be a good doctor. In these days of rapid scientific advances, we can’t know it all, so we need to be good at analyzing information and then figuring out how best to implement it in the care of a patient. Dr. DeWaters suggests that the goal of residency training is not to become an encyclopedia, but to attain what she calls “citizenship.” She defines that as, “the mindset to contribute to holistic needs of individual patients, populations and health systems.”
She and a team of educators from Penn State, Virginia Tech, Kaiser Permanente, Allegheny Health Network and Geisinger sent out a survey asking residents across 10 training institutions to nominate core faculty members who they found to be exceptional “system citizens.” From 289 nominations, 11 physicians were selected as standouts and interviewed about their work by a team of researchers. After interviewing the outstanding physicians identified by residents, Dr. DeWaters and her colleagues identified eight characteristics of an “exceptional systems citizen”, which are as follows:
Such physicians:
- Are generous, selfless, humble, adaptable and resolute.
- Express values that drive behaviors “above and beyond” their colleagues’ expectations.
- Are intentional about—and experts at—teaming.
- Are calm in the “eye of the storm.”
- Employ a wide array of creative systems thinking skills to solve problems.
- Have exemplary interpersonal and communication skills.
- Teach systems-based practice as part of clinical care.
- Identify personal and professional mentors as key to their development.
I think that’s a pretty good list, although I do struggle with some of the buzzwords. I am not sure how I’d feel if I was identified as “an exceptional systems citizen.” I still feel like my first obligation is to the patient in front of me and not to any system, but I am aware that the decisions I make or the treatments I recommend for each patient have an impact on “the rest of the system,” which includes Medicare or private payer dollars, and how we apportion scarce resources (including our own human resources).
It’s insulting to think that I can make a better list when I have done zero research in the area. But I did translate a few of these into simpler language that helps me internalize them. I have been thinking a lot about the doctors I know who give us all a bad name by being demanding, belligerent, and condescending – particularly to support staff. I am thinking of doctors who abuse opportunities to generate revenue at the expense of the Medicare trust fund and the patient, and I have been thinking about the ways that I have failed to be a good mentor or to appreciate members of my staff.
Here’s my personal list – the attributes to which I aspire, even though I miss the mark often, which is to be:
- Generous, selfless, humble, adaptable, and determined.
- Express values that are driven by a higher (and unmovable) moral standard rather than by whatever standard is currently considered acceptable behavior.
- Committed to the importance of team work and to be a good team member.
- Creative at solving problems (which includes listening to the ideas of others).
- Have exemplary interpersonal and communication skills.
- Mindful of the use of limited resources (including the patient’s) and not to prioritize my own economic benefit in clinical decision-making.
- A good mentor to those who seek it – and to continue to find mentors for my own growth and development, and to listen to well-deserved criticism.
- NOT to be condescending and rude to members of my team or my patients, my colleagues (or my family).
The first step is deciding what sort of people we want to be. The second is to realize that nothing on the list requires being the smartest person in terms of knowledge. These are all skills and behaviors that can be learned. I could be better. I could do better.
Feel free to tell me about your list in the comments below.
Caroline
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
