Sketches| Volume 218, ISSUE 4, P459, April 2018

The most important quality of a physician

Published:January 03, 2018DOI:
      An aspiring doctor recently recounted to me a question from one of his medical school interviews. “Which of the following traits,” he was asked, “is most important for a physician: scholarship, compassion, communication skills, or personal ethics?” This kind of introspective question has become increasingly common in interviews for medical schools whose admissions committees now emphasize more than ever the importance of assessing a candidate’s values in addition to their aptitude for science, academics, and analytical thought.
      Despite having been told in advance that such questions would have no single correct answer, the applicant panicked. He knew that all the traits were important. How could he pick only one? And if he chose only one, how could he do so without seeming to suggest that the others were less important? On the other hand, if he answered that all were important he would be falling into an obvious trap and would appear indecisive. The interviewer had made it clear that he expected a single answer with an accompanying justification. Besides, the candidate had no real experience in the practice of medicine; what if one of the traits in fact is most important? And what if the interviewer had his own opinion on the matter and would assign a poor score to the applicant if he failed to confirm that opinion?
      The question reminded me of an old joke, a version of which is recounted in the book How to be a Jewish Mother: A Very Lovely Training Manual, by Dan Greenburg. A Jewish mother buys her son two shirts. The next morning he comes down for breakfast wearing one of the shirts. In a voice heavy with disappointment she asks: “The other one you didn’t like?”
      The request to rank an unrankable list seeks, among other things, to assess how the candidate deals with ambiguity under stress. I don’t know how I might have responded during a high-pressure interview in my youth, but as I sit here in the comfort of my desk chair after more than 25 years in practice as an obstetrician-gynecologist, I answer the question thus:
      A good physician requires all the traits cited in the question: scholarship, compassion, communication skills, and personal ethics, but though they are necessary these characteristics are not sufficient. A partial list of other important qualities includes intelligence, knowledge, skill, confidence, humility, integrity, creative thinking, the capacity to both lead and function as a member of a team, and, my personal favorite, judgment. Good medicine requires some mixture of these traits, but not in equal measure or in fixed proportions. To do the right thing, I must be able to give each patient what she needs when she needs it. This might mean sitting at her bedside and holding her hand. It might mean consulting a colleague or performing a literature search. It might mean removing her uterus to save her life.
      The importance of a doctor’s readiness to tailor care to the patient was made plain to me on a personal level when I required a surgical procedure a few years ago. While searching for the best physician for the task, I consulted with a semi-retired and revered specialist who no longer operated himself. I told him that I wanted the best technical surgeon to perform my procedure and that, despite my aspiration to be empathetic and compassionate for my own patients, I could dispense with “the touchy-feely stuff” for myself.
      “You are wrong to think so,” the specialist replied. “You want a doctor who really cares about you as a person, someone who will do the right procedure in the best way possible because that is what you require, not because it satisfies his or her own needs. Someone who will be there for you if you have a complication and who will treat you with compassion if you turn out to be more vulnerable than you suppose.” The wisdom of these remarks was immediately apparent.
      Each doctor has strengths and weaknesses. Many of us aspire to an idealized concept of physicianhood in which all the important elements are present in abundance. The fact that this ideal is unattainable may not be so important. At least it provides a North Star.
      So, which of the many noble qualities of a physician is most important?
      The one the patient needs.