Measuring patient outcomes is one way to determine how “good” a doctor is – but it is far from the only way. In our obsession with measuring performance, we seem to have forgotten that.
In medicine we measure a lot of things. We measure procedure times, length of stay in the hospital, complication rates. As a chief of cardiology, I’m involved in measuring a wide range of metrics, from how quickly the patient receives treatment (door-to-balloon time) to major adverse cardiac event (MACE) rates, and numerous other measurements. The medical field has spent the last decade developing metrics to assess quality of health care, and certainly these measures have value.
But by themselves, these metrics are inadequate to answer the patient’s most essential question, “Do I have a good doctor?”
We seldom measure whether a doctor is available after hours when their patient has a concern. We seldom measure doctors’ ethics or whether they are able to meet the emotional needs of a patient. We seldom measure a doctor’s willingness to refer a patient to another physician if that person can better meet the patient’s needs. Yet to a patient, these things can be every bit as important as outcomes.
Most health care professionals know a “good doctor” when they encounter one. Being a good doctor is not the same as a career achievement award such as being named a “master clinician.” Often we recognize “good doctors” among younger physicians-in-training, or junior faculty members, as well as some, but not all, senior faculty members. Patients can identify “good doctors” without ever knowing what they scored on their Board exams.
I heard a lecture about “leadership” last year at the U.S. Naval Academy and was struck by how the qualities required of future military leadership could be adapted to the best qualities of a health care provider. At my hospital in New Orleans, we have a cardiology fellowship training program, and I try to communicate these measures of “physician quality” to these young physicians-in-training, which I call the “Five C’s”:
- Character: Physician character can be measured by such traits as honesty, confidentiality, humanity, humor, candor and ethics.
- Compassion: Compassionate physicians are emotionally driven to help their patients feel better. They treat their patients as they would treat a family member.
- Commitment: These physicians are available when their patients need them, and considered hard-working by their peers. They take “ownership” of their patients’ problems, and work to resolve them.
- Courage: Physicians who do what’s best for the patient even when it’s not in the best interest of the physician, such as making a referral or giving up a procedure. Physicians with courage have difficult conversations and are able to make judgments in the face of uncertainty to provide the best care for their patients.
- Competence: Physicians who have the required knowledge and technical skills and work hard to keep themselves up to date.
Unfortunately, most of our quality measures today focus solely on the final quality – competence – and fail to truly measure many of the qualities that make a good doctor.
What do patients look for in a “good doctor”? First and foremost are strong intellectual skills. Good doctors are life-long learners. Good doctors must have the emotional maturity, clinical experience and judgment to make difficult and complex decisions under conditions of uncertainty and ambiguity. Among all health care professionals, good doctors must be willing to accept ultimate responsibility for medical decisions the guidelines will not address.
Securing the trust of a patient and of one’s colleagues is what “good doctors” do. And they do the right thing for the patient, even if it isn’t always the best thing for their hospital, their practice or themselves. It’s not that good doctors never make mistakes – they do. It’s not that they are all knowing or all seeing – they aren’t. They may not have the highest exam scores or be the most efficient, but they are the doctors we trust to care for us.
Good doctors are an absolute requirement for delivering high-quality health care to a patient, but even a good doctor in a poorly organized or poorly financed health care system may not be able to deliver good quality outcomes.
As our national health reform discussion continues and we decide to seriously embrace quality of health care issues, it’s time we focus on teaching our medical students and physicians-in-training what physician quality truly means. And it’s time we develop a broader assessment of what makes a “good doctor.”
Christopher J. White, MD, FSCAI, is chairman of the Department of Cardiology and director of the Ochsner Heart and Vascular Institute in New Orleans. He serves as secretary of the Society for Cardiovascular Angiography and Interventions (SCAI). Dr. White graduated AOA from Case Western Reserve University and completed his specialty training in internal medicine and cardiology at Letterman Army Medical Center in San Francisco. He has been elected to Fellowship in the American College of Cardiology, the American Heart Association, the European Society of Cardiology, the Society of Vascular Medicine and Biology, and the Society for Cardiovascular Angiography and Interventions. He is editor-in-chief of the interventional cardiology journal “Catheterization and Cardiovascular Interventions.”