In this study, what it means to be a good doctor is described as being a professionally dedicated doctor, who is highly available in the workplace and willing to work efficiently and make supreme efforts to achieve this (high work capacity). Maintaining excellent professional skills appeared to be a fundamental precondition for most of the doctors.
Statements by doctors in this study to the fact that they extended their working hours to upgrade their professional knowledge are confirmed by previous studies, in which hospital doctors in a number of specialties stated that at least 45 hours per week are needed to ensure adequate specialisation (22). Self-imposed overtime among doctors has previously been shown to reflect the distance between the doctors’ own assessments of the time needed to maintain a sufficient level of professionalism on the one hand and demands for cost-effectiveness on the other (23).
Attendance beyond normal working hours and «the willingness to put in some extra effort» may be similar to the ideals of the unselfish helper who disregards his or her own needs. Little has been written about the practical implications of altruism (24). The absence of a norm regarding what is «good enough» may complicate the search for a work-life balance.
We are aware of few other studies that investigate doctors’ views of what it means to be a good doctor, but much research has been undertaken on medical professionalism. Good professionalism is often defined indirectly through descriptions of unprofessional behaviour (10). We therefore needed to explore indirect ways to describe what a «good doctor» is. Instead of speaking about what it means to be a good doctor, the doctors spoke about colleagues who did not «adapt» or were insufficiently «ambitious». In line with our study, previous international research has pointed out the difference between regarding the medical profession as a lifestyle as opposed to regarding it as a job (25, 26).
Many of our respondents believe that the younger generation has replaced the ideal of altruism with their own interests when placing greater emphasis on their private lives and families (26, 27). The structure of the split duty periods and shorter working hours may have caused younger doctors to feel less personally responsible for their patients (28) and thus less committed to their work as doctors.
The trend towards constantly new subdivision of tasks and sub-specialties may come at the cost of continuity of treatment. Technological advances and dealing with new biomedical knowledge often tend to displace the more humanistic aspects of medicine (29). On the other hand, senior consultants’ and specialty registrars’ differing views on the doctor’s role may also represent a cohort effect, meaning that today’s young doctors will be socialised into the role of the doctor as «a lifestyle» later in their careers.
These expectations for intensive and effective work corroborate previous research showing that hard work is a ubiquitous norm in the medical profession (30). The willingness to put in extra effort appeared to be fundamental to the doctors, as well as an expression of dedication, as something that endowed them with legitimacy among their colleagues. Experience is crucial in the medical profession, and obtaining medical competence is a matter of life-long learning. The challenge that emerges here is the question of whether it is at all possible to be «good enough» as a doctor.
With regard to the general topic of what it means to be a good doctor, the differences that we found between the senior consultants and the specialty registrars were more pronounced than those between the genders. Few differences between male and female doctors have previously been found in terms of job satisfaction (31). As regards the everyday consequences of such job ideals, however, it has been shown that women and men handle the work-life balance differently. Women reduced their number of hours worked to a greater extent than men, despite an equally large care burden measured by their number of children (32). This non-reduction of working hours among men is correlated with emotional exhaustion (burn-out) later in their careers (33).
Using the available data material, we have also analysed the challenges that hospital doctors face when seeking to live up to the ideals of the good doctor. The results will be presented in a separate article.
The strength of a qualitative study is that it generates experience-based knowledge, rather than quantitative rankings. This restricts its generalisability. However, the external validity of this study’s findings is enhanced by the inclusion in the material of doctors from a large, centrally located and a small, local hospital, doctors from various medical specialties, and specialty registrars as well as senior consultants (34).
Recruitment for the study may have resulted in a sample of doctors who had a particular interest in the topic. We may also have selected doctors with better opportunities to work long hours, because the interviews were conducted at the end of the working day. The fact of having three individual interviews and eight group interviews may have affected the results because of the different dynamics inherent in the two forms of interviewing. The participants in the individual interviews would have had less time to speak in a group, and their statements would have been affected by what others said, and vice versa. This may have caused us to give these participants more space in our study than the individual participants in the focus groups.
The fact that the moderators were doctors may on the one hand have facilitated understanding and recognition of what was described, but also entails the risk that one’s own assumptions may have affected this understanding. The «insider» perspective may have caused some factors that were assumed to be known to all doctors to be taken for granted and not explicitly mentioned. During the analysis, we have looked for variations around the main topics in order to reinforce the internal validity of the findings. The findings have also been presented and discussed in various fora and submitted to the participants.