How to be a good doctor

1. Eric Mugambi
BMJ VOLUME 325 28 SEPTEMBER 2002 bmj.com

2. Traits of a good doctor
The practice of medicine will be very much as you make
it - to one a worry, a care, a perpetual annoyance;
to another, a daily job and a life of as much happiness
and usefulness as can well fall to the lot of man,
because it is a life of self-sacrifice and of countless
opportunities to comfort and help the weak-hearted,
and to raise up those that fall.

3. A good doctor
• Observe, record, tabulate, communicate.
Use your five senses. Learn to see, learn
to hear, learn to feel, learn to smell, and
know that by practice alone you can
become expert.
William Osler

4. Challenges
• Trying to make doctors ‘too good’
• Master several disciplines
• Insurance specialists, anthropologists, ethicists,
marriage counselors, small business owners,
economists, social workers
• Media: doctors miss depression, family/ sexual
abuse, ignore sub-cultural beliefs
• Doctors don’t understand computers/ systems
• Ignore patients spiritual needs

5. In seeking absolute truth we aim at the unattainable and must
be content with broken portions.
• Society is becoming more ‘medicalised’
• More social problems, law enforcement,
religious e.g. alcohol, stress, violence
• Expectation on doctors is to know more and
more
• Can doctors assimilate all this information?
– How well?

6. A good doctor…
• Must be technically proficient in the craft of
medicine
• Must understand patients in enough breadth to call
on a community of skilled healers – nurses, social
workers, chaplains, psychotherapists, physio-
therapists, yoga practitioners
‘He who studies medicine without books sails an uncharted sea,
but he who studies medicine without patients does not go to
sea at all.’

7. Doctor must be ‘touched’ by the patient’s
life, as well as their illness
‘It is much more important to know what sort of a patient has
a disease than what sort of a disease a patient has.’
William Osler

8. A good doctor…
• Respect people, healthy or ill, regardless of
who they are
• Support patients and their loved ones when
and where they are needed
• Promote health as well as treat disease
“The young physician starts life with 20 drugs for each
disease, and the old physician ends life with one drug for 20
diseases.”

9. "The killing vice of the young doctor is intellectual laziness."
• Embrace the power of IT to support people
with the best available information, while
respecting their individual values and
preferences
The philosophies of one age have become the absurdities of
the next, and the foolishness of yesterday has become the
wisdom of tomorrow.

10. Always ask courteous questions, let people
talk, and listen to them carefully
Look wise, say nothing, and grunt. Speech was given to
conceal thought.

11. A good doctor…
• Give unbiased advice, let people participate
actively in all decisions related to their health
and health care, assess each situation
carefully, and help whatever the situation

12. A good doctor…
• Use evidence as a tool, not as a the sole
determinant of practice;
It is much simpler to buy books than to read them and
easier to read them than to absorb their contents

13. A good doctor…
• Humbly accept death as an important part of
life; and help People make the best possible
arrangements when death is close
Courage and cheerfulness will not only carry you over the rough places in
life, but will enable you to bring comfort and help to the weak-hearted and
will console you in the sad hours

14. A good doctor…
• Work cooperatively with other members of
the healthcare team
No human being is constituted to know the truth, the whole truth, and
nothing but the truth; and even the best of men must be content with
fragments, with partial glimpses, never the full fruition

15. A good doctor…
• Be proactive advocates for their patients,
mentors for other health professionals, and
ready to learn from others, regardless of their
age, role, or status
By far the most dangerous foe we have to fight is apathy -
indifference from whatever cause, not from a lack of knowledge,
but from carelessness, from absorption in other pursuits, from a
contempt bred of self satisfaction

16. The desire to take medicine is perhaps the greatest feature
which distinguishes man from animals
• When did you have your last health check?
• Have you seen a physiotherapist for your back
pain?
• Have you tried quitting cigarettes?
• Would you like to know more on your
diabetes?
• Have you tried any diets to lower your
cholesterol?

17. The doctor of the future will give no medicine but will interest
his patients in the care of the human frame, in diet and in the
cause and prevention of disease. ~Thomas Edison
• You mentioned your mother had a back
problem, has she been to the doctor?
• When was your last HIV test?
• Have you been to a dentist?
• Where did you have your last baby?
• Did you see a counselor after your
miscarriage?

18. SOPs
• Do not replace ‘good clinical habits’
• Used well, they augment patient-doctor
relationship
• Standardize practice – Labs, procedures, Imaging,
treatment, admission, referral
• Improve patient satisfaction
• Improve patient care
• Research oriented
• Reduce work burden

19. Health as an asset
• Health is a state of complete physical, mental and social well-
being and not merely the absence of disease or infirmity -
WHO
• The patient does not care about your science; what he wants
to know is, can you cure him? ~Martin H. Fischer
• The Lord hath created medicines out of the earth; and he that
is wise will not abhor them. ~Ecclesiastes 38:4
• If you are too smart to pay the doctor, you had better be too
smart to get ill. ~African Proverb

20. The doctor as custodian of health
• The good physician treats the disease; the great physician treats the
patient who has the disease
• In nothing do men more nearly approach the gods than in giving health
to men. Cicero
• My doctor is nice; every time I see him, I'm ashamed of what I think of
doctors in general. Mignon McLaughlin, The Second Neurotic's Notebook, 1966
• Restore a man to his health, his purse lies open to thee. Robert Burton
• The physician should look upon the patient as a besieged city and try to
rescue him with every means that art and science place at his
command. Alexander of Tralles

21. Thanks
Who ever thought up the word
"Mammogram?" Every time I hear it, I think
I'm supposed to put my breast in an envelope
and send it to someone - Jan King