As doctors, we like to do well, and the «logical» approach to good performance is to hold in high esteem things that are easily measured. That is probably why we commend the doctor who can reel off dosages and treatments. Do not misinterpret us – it is beyond doubt that the accomplished doctor must have medical knowledge and technical skills at her fingertips. However, she needs more than that to be an accomplished professional – more specifically, qualities such as empathy, pragmatism, the ability to reassure, decisiveness, dedication and wisdom.
Our impression is that such qualities are often not taken into account when judging professional accomplishment in medical training and medical practice. It is a pity if professional conduct and the humanistic traits of medicine are overlooked when judging overall professionalism because they take longer to detect, are difficult to measure and are poorly suited for ranking.
We have outlined two competing understandings of professional accomplishment. A narrow understanding, which implies extensive academic learning and technical competence, and a broad understanding, which also includes those qualities that allow us to understand and treat patients better. We envision a number of objections to this broad understanding of professionalism and will address some of them here.
First: As doctors, we are required to prioritise, and one may view this in an overly simplistic way as: «When it comes down to it, the role of the doctor is to make the correct diagnosis and give the patient the correct treatment.» But is this enough? It is not always clear what the right diagnosis or treatment might be. The wishes of the patient and how he or she experiences the consultation with the doctor are important too, also for the treatment. It often requires a great deal of ingenuity to work out what is «in the patient’s best interests.» Moreover, if we allow the patient to speak freely, and listen actively, in most cases we will probably arrive at the correct diagnosis more quickly (4).
Second: «We should choose the cold and knowledgeable doctor over the warm and ignorant.» Who would not prefer Dr House over Dr Dolittle? In the real world, this is hardly a necessary choice since there is probably not a negative correlation between intelligence and empathy. The professionally accomplished doctor must exercise and practise all aspects of her work.
Third: Some may argue that professional accomplishment is reserved for the most «experienced» doctors. Is there a causal relationship between the number of hours at work and professional achievement? The results of Hertzberg et al. show that doctors themselves believe that a good doctor is a dedicated physician, and that professional dedication can be measured by how much time the doctor spends at work and how efficient she is (5). If this is true, the oldest will triumph because they have the most experience. But experience without reflection does not necessarily lead to improvement. It can just as easily consolidate bad habits. Experience is not always the best teacher.
We can define our profession in many ways, but reducing it to pure physiology, algorithm cramming, or to diagnostic criteria or procedures is unhelpful. It deprives us of the opportunity to perform our jobs well. It also deprives the patient of accomplished doctors. If we exclusively foster qualities that can to a large extent be automated, we threaten the future role of the medical doctor (6, 7).
Medicine is at the intersection of several disciplines (8). It encompasses elements of natural sciences, social sciences and the humanities – and not least extensive experience and wisdom. To be an accomplished doctor is, therefore, difficult, but not impossible. A step in the right direction is to discuss what we think medical professionalism ought to be. The accomplished doctor has many qualities that should be practised from the first day of study and throughout the entire career, and which must not be overlooked or downgraded because they cannot be measured as well or as simply as other skills.