A lot of people wonder: "Do I have a good doctor? How can I tell?" It is hard for most of us to know whether or not a physician is truly skilled.
But here is one description of a good doctor's qualities:
"An inquiring, analytical mind; an unquenchable thirst for new knowledge; and a heartfelt compassion for the ailing -- these are prominent traits among the committed clinicians who have preserved the passion for medicine."
In homelier language, if a doctor obviously enjoys -- passionately enjoys -- the practice of medicine, shows evidence of following new developments, obviously thinks hard about you and your problems, asks questions of you, shows a real interest in the answers and in addition treats you humanly, you probably have a good doctor.
The description quoted above is from an arresting and timely new book, "Preserving the Passion" (Springer-Verlag, $35), by Dr. Phil R. Manning of the University of Southern California and Lois DeBakey of the Baylor College of Medicine in Houston.
There is a lot of talk these days about the demoralization of doctors, their anger and discouragement over the criticism, scrutiny, regulation, malpractice suits and often plain rancor they've been facing.
Some of that flak is deserved. A good deal is not. In either case, many physicians have been saying the fun has gone out of medicine and they wouldn't advise their children to go into it.
In reply, Manning and DeBakey offer doctors a prescription: Immerse yourself in lifelong, largely self-directed learning, in solving your patients' medical problems, in helping them with their human problems, in examining your treatment, assessing your successes and mistakes to keep improving yourself as physician and healer. Then, they say, you will know "the enjoyment, satisfaction and exhilaration," the joy and gusto of "intellectual expansion and service," and you will "preserve the passion for medicine." The pitfalls may then be seen in clearer perspective.
Manning is a leader in medical education, DeBakey -- sister of famed surgeon Michael DeBakey -- a celebrated teacher of clear medical communication. Their book is written to tell doctors the many old and new ways in which the more than 600 excellent physicians they interviewed use their prescription. But the characteristics they observed also tell us much about those a patient might look for in judging any kind of doctor.
They suggest people should look for doctors like these:
Someone who is interested, not bored or blase', who finds pride and enjoyment in medicine and plainly sees it as "a grand and possessive discipline that requires a lifelong interest in things human."
A doctor who -- usually at least -- gives you time and unrushed attention. "Perhaps the most significant barrier in the doctor-patient relationship is the physician's failure to give full attention to his patients. He may need to reduce his patient load to provide unrushed time . . . There is no substitute for an excellent physical examination and penetrating analysis of the medical history and symptoms." But "some physicians look at their patients and make a snap diagnosis without giving the patient time to say everything he has to say."
A listener. Someone who gives you a chance to talk without interruptions or impatient "uh-huhs." And whose responses show that you have been heard. Many doctors "are so busy asking questions that the patient can never tell a full story."
A questioner. Someone who asks precise questions -- what, where, when and why -- and shows curiosity about you. Also, someone who shows intellectual curiosity, relish in keeping up with medicine and talking about new advances.
Someone who shows that he or she cares about you by treating you "as a fellow human being whose unstated fears, anxieties and dependence associated with illness also require attention." Who makes you feel less anxious or fearful -- and who also makes sure that you understand any instructions or decisions.
A doctor who cares about making you well, and cares more about it than about money. One sign of caring -- and of competence based on self-analysis -- the doctor who follows up after days, weeks or months to find out how a treatment worked.
A partner. Someone who presents explanations and alternatives and helps you decide what should be done, not just what might be done, and then teaches you how to manage.
Someone who admits sometimes, "I don't know," and is ungrudgingly willing to seek help or consultation. One doctor says: "Patients appreciate the physician who seeks another opinion even when he thinks he knows the answer."
A doctor who regularly confers with colleagues to check and sharpen his or her knowledge, or who teaches or acts as an "attending" or volunteer staff member at a university or other teaching hospital. Doctors who teach learn by teaching, and the fact that they are permitted to teach speaks to their competence. ::
"Medicine," write Manning and DeBakey, "is a demanding profession that consumes inordinate time, attention and effort," one of "pressing responsibilities, sensitive interpersonal relationships and strenuous time pressures."
Few doctors will live up to every one of the above virtues every minute of every day. Few can be as consistently self-confident or medically correct as some of the heroes on "St. Elsewhere" or "M.A.S.H." Patients must learn this, too.
And not every doctor can be a warm Dr. Feelgood. For some, competence in itself is the best sign of compassion.
Still, most of us want to feel good about our care. That is why we will benefit if educators like Manning and DeBakey succeed in making every doctor's office a place of medical learning as well as medical care, a place where continuing passion for learning and caring replaces the drudgery medicine can become for the doctor who ceases to learn or care.
If your doctor says, "I just read that . . ." or "we're learning that . . ." or "the latest research shows that . . ." or "we've found looking at our own cases that . . ." you may very well be talking to one of the best.