The good doctor

Are you a good doctor? The popular TV series, The Good Doctor, an ABC remake of the Korean medical drama, portrays the Good Doctor as a surgeon, with autism, and savant syndrome. However, the Good Doctor himself, the main actor Freddie Highmore, doesn't think he would be a good doctor in real life. And surveys of patients, the general public, and doctors would agree. They describe other essential important qualities of a good doctor. When I think of what's needed to be a good doctor, I think of expert level clinical acumen and interpersonal/communication skills. The expert level clinical acumen, which we attain by our many years of training, and which justifies this level of training, approaches the Japanese concept of shokunin, an artisan deeply and singularly dedicated to his or her craft. This is an important aspect of Japanese culture, and when it comes to food, Tokyo is said to be the city of 10,000 shokunin. Clinical acumen is also what most doctors prioritize in a good doctor and is reflected in what we spend our time on in our ongoing professional development. Our conferences are all about improving knowledge and skills. Patients, on the other hand, more highly value a doctor's ‘bedside manner’, or effective communication skills. This includes empathy and compassion (for the difference see https://www.youtube.com/watch?v=XXb2awAbmUA). There is now strong evidence documenting the positive health effects of compassionate care. It is not only patients who value communication skills in a good doctor. Medical educators prioritize these skills, including at entry to medical school, and so do medical insurers, with good reason. Junior doctors at the end of residency training who had low ratings in professionalism and interpersonal communication skills were found to be at increased risk for patient complaints when they entered independent physician practice (https://doi.org/10.1001/jamanetworkopen.2023.7588). The medical insurer Avant reported that 40% of medicolegal claims and complaints against the medical profession involved communication (https://avant.org.au/resources/doctor-patient-communication). It is a concern that empathy declines during medical training (https://doi.org/10.1111/j.1365-2929.2004.01911.x) and practicing clinicians often lack empathy (https://doi.org/10.3399/bjgp16X683761). After graduation, how often do we train and assess these skills? There is a need to transform our approach and practice. Some groups are already doing this (https://doi.org/10.1080/0142159x.2024.2390035). Evidence suggests that training can enhance physician empathy and compassion (https://doi.org/10.1371/journal.pone.0221412). So, our medical educators get it, but what about the conference organizing committees? Curiosity is an interesting aspect of this topic. Curiosity in a doctor is positively linked to effective lifelong learning. Among younger physicians (mean age 33 years), curiosity was seen as a driving force for (lifelong) education, important in building empathetic physician-patient relationships, and as a core quality of a good researcher (https://doi.org/10.1080/07853890.2024.2392887). But it could be blocked by workplace issues such as heavy workloads, time constraints, stress, and lack of autonomy. There is also some disruption happening in this space, coming from the rise of telehealth and AI. When asked, two thirds of people ‘would rather be treated by a human doctor who is more likely to make a mistake but offers compassion than by a robot doctor that rarely makes a mistake but lacks compassion’ (https://www.healthwatchsutton.org.uk/news/2018-09-26/would-you-rather-be-treated-fallible-human-or-compassionless-robot-healthwatch). But when studied, large language models such as Chat GPT give more empathetic responses to questions than real health professionals. So why do people prefer a real doctor? Maybe Chat GPT just isn't curious. When it comes to telehealth, web-based video consultations can offer the same interaction quality and participant satisfaction as face-to-face consultations (https://doi.org/10.2196/jmir.8033), which brings us back to the communication skills of the health professional, rather than the medium used. These developments are likely to be useful tools, if we can learn the best ways to use them. So, are you a good doctor? Are you managing your professional training to ensure both clinical acumen and interpersonal/communication skills are developed? As an aside, in August 2022, it was reported that The Good Lawyer was in development at ABC(USA) as a spin-off from The Good Doctor. It was later cancelled… mmmmm. None declared.