What Makes a Good Doctor "Good"?

Attention, connection, validation, and empathy lead to compassionate caring.

Posted Oct 06, 2020

Questions like this are open-ended but reasonably answered. Besides ample knowledge and good training, a doctor’s personality contributes to the practice of good medicine—recovery-oriented and shared decision-making.

Among the valuable characteristics of good doctors are listening and observational skills. Active connectedness encourages empathy, high reliability, and safety, the foundations for effectiveness.

Original photo by author, Frank J. Ninivaggi MD
The Doctor's Tools: Hands
Source: Original photo by author, Frank J. Ninivaggi MD

Personality Factors and Their Sub-facets

Personality is the stable pattern of functionally related processes that include cognition, emotion, interpersonal relatedness, behavior, coping, and defenses.

H.J. Eysenck (1916-1977), a controversial British psychologist, first proposed a personality model that had two dimensions: extroversion-introversion (i.e., “E”) and stable-unstable (i.e., “N,” representing neuroticism). More robust and nuanced studies have produced the now-used “Big Five” personality model (Costa and McCrae 1992).

The Big Five factors are

1.  Openness to Experience

2.  Conscientiousness

3.  Extroversion

4.  Agreeableness

5.  Neuroticism or Negative Emotionality

People have all five factors and can be higher or lower than other people on each one. Each characteristic or trait, with its many subordinate traits (i.e., “facets”), is a descriptive dimension yielding endless personality styles. The facets interacting in differing contexts impart one’s unique character. The emphasis is on personality styles rather than psychiatric disorders, as found in the DSM-5.

Openness to Experience includes being open-minded, creative, adaptable to new perspectives, and intellectually curious, to name a few aspects. Flexible mindsets rather than mental rigidity characterize its dimensions.

Conscientiousness includes the sub-traits of being organized, aware of details and planning, following tasks to completion, being reliable, self-directed, persistent, industrious, maintaining “effortful control,” and being efficient. For doctors, the mental set of always “still learning” leads to creative problem-solving.

Extroversion signifies people who are energetic, assertive, gregarious, and outgoing. These “surgency” qualities can be challenging and stimulating. All interpersonal and social connectedness rests on the balance between extroversion and introversion, notably with the patient.

Agreeableness includes kindness, empathy, compassion, helpfulness, cooperativeness, sharing, and being friendly. These are “social lubricants.” Receptivity without judgment, ability to pause, and lingering with experiences are qualities of many agreeable people. Thus, safe spaces for continued dialog open. People who are high in this factor do not argue or oppose with criticism and premature judgment. Reactively argumentative people oppose what others say. This obstruction shuts down productive conversations by stirring fear and anger, all of which block understanding. Being productively agreeable does not require blind agreement but only considering another’s ideas, i.e., validating that they are their truth. This “relational mentalizing” is understanding even if short of acceptance. Agreeableness emphasizes emotional caring that rounds out cognitively conscientious care.

Neuroticism or negative emotionality reflects negative, unstable moods seen in stress, anxiety, worry, depression, anger, hostility, loneliness, and despair. Being able to readily adapt in the face of uncertainty counters negativity and opens onward exploration.

What Personality Facets Make a Doctor “Good”?

Most studies about good doctors show that high scores on Conscientiousness and Agreeableness correlate with good or stable mental health. The willingness to help is a large part of the factor of Agreeableness. Studies have suggested that well-modulated Conscientiousness and the wish to help are protective against the burnout syndrome. Implied is a heightened psychological resilience.

Almost two decades ago, the British Medical Journal (BMJ, 2002) devoted an entire issue to elaborating good doctors’ qualities. These included:

·  Compassion/Warmth

·  Understanding

·  Empathy 

·  Honesty

·  Competence 

·  Commitment 

·  Humanity

·  Courage

The Takeaway

The people we consider "good" often share the following characteristics:

· observant 

· receptive 

· attentive listener 

· curious 

· can tolerate ambiguity 

· can manage temporary gaps in understanding without undue frustration and negativity 

· seeks to improve problematic dilemmas (for doctors: e.g., symptoms) toward more favorable outcomes.

Goodness implies respect for the value of persons. Attentive listening sets the stage for trying to understand both their perspective and yours. A working hypothesis about diagnoses and a treatment plan emerges for good doctors. As opposed to simply demanding compliance or adherence, a mutual dialog elicits a participatory therapeutic alliance and yields better outcomes.

Doctors considered “good” often say the rewards of their profession are the gratitude felt for meaningful relationships with patients, helping them to improve, and using skillful resources for finding workable solutions. These rewards override the difficulties of complex regulations, complicated patient presentations, and long hours. Remaining mindful remains a therapeutic asset.

The Journal of the American Medical Association (JAMA 2014) proposed more updated perspectives but concluded by saying that the entire endeavor to define a “good” doctor remains “a work in progress.”

References

BMJ (British Medical Journal). (2002).  “What's a good doctor?” 28 September 2002(vol 325, issue 7366)  doi: https://doi.org/10.1136/bmj.325.7366.0/g 

Lee, T. H. (2014). “Certifying the Good Physician: A Work in Progress” 

JAMA (Journal of the American Medical Association), 312(22):2340-2342. doi:10.1001/jama.2014.13566

Ninivaggi, F.J. (2019). Learned Mindfulness: Physician Engagement and MD Wellness. Cambridge, MA: Elsevier Academic Press.

Cattell, R (1950). Personality: A systematic theoretical, and factual study. New York: McGraw-Hill.

Costa, P.T., Jr., & McCrae, R. R. (1992). Revised NEO Personality Inventory Manual (NEO-PI-R) and NEO Five-factor Inventory (NEO-FFI) professional manual. Odessa, FL: Psychological Assessment Resources.

Trzeciak, S. Mazzarelli, A. (2019). Compassionomics: The Revolutionary Scientific Evidence That caring makes a difference. Studer Group, Pensacola, Florida.