What makes a high quality physician?

For those who do not visit regularly, last week I asked 2 questions:

• Consider your ideal clinical physician (family physician, internist, pediatrician, ob-gyn, surgeon, subspecialist). Please write in the comments section the 3 most important characteristics in choosing a clinician. What characteristics would you, or have you, desired? - for non-physicians
• Consider all the clinical physicians you have known. Some clearly stand out as the highest quality physicians. Please write in the comments section the 3 characteristics that you use to value high quality physicians. Thanks – for physicians

I received over 30 comments, some short and some long. The responders showed much thought, and clearly responded maturely. Interesting to me the responses of physicians and non-physicians had great similarities. I did note a couple of differences.

Both groups stressed knowledge. The admire smart physicians. I must confess that this answer requires more granularity. How do we define a knowledgable physician? Are we concerned about test scores? As I consider this issue, my main concern is whether the physician can apply that knowledge to clinical problem solving. I would love some readers thoughts on this issue. Please identify yourself as a physician or not.

Physicians more often used words like compassion and communication, while non-physicians seemed to stress bedside manner. The physicians may underestimate the importance to patients of the many aspects of bedside manner. I read terms like respect, partnership, lack of condescension in the non-physician responses. Physicians stress compassion and communication. I suspect the difference in word choice stems from our accustomed role in the doctor-patient relationship, but would appreciate physician thoughts on this concept.

The non-physicians more often cited intuition or decision making than the physicians. I suspect that many physicians assume clinical judgement/decision making is part of knowledge, but I personally would separate those two concepts. Again, I would love more discussion of this issue.

More physicians than non-physicians worried about humility. As physicians we are easily seduced by the power of our positions. The best physicians that I know do a good job of not overreaching. I worry about physicians who start to believe their press clippings.

Finally, many patients worry about timeliness and availability, while this did not make any physician list. This issue seems obvious, and something that we physicians should give focus.

Only one non-physician was interested in “report cards”. Several non-physicians mentioned charges for visits.

Thanks to all who left comments to these questions. I plan to continue my exploration of this issue. My reading of the responses suggests that physicians and non-physicians understand the difference between quality and performance measurement. If we want to encourage quality, then we must define quality and reward it. Performance measurement, as currently implemented, encourages certain desirable behaviors, but these should not be considered a definition of quality.