Recently on Twitter there was some discussion about what were the essential characteristics of a good doctor. The initial tweet said:
This was followed by replies suggesting other words beginning with C: “I’d add curious and concerned.” And “whatever synonym for humble that begins with c”. Others said “great mnemonic. I might add: Considerate.” And “Can I add a fourth C? Communicative”. All worth discussion. The occasional game tweeter suggested additional words beginning with A.
Someone else noted it reminded them of a poster for the 6 C’s (in the NHS) and a reply to that was “Interesting. “C” is obviously key. The signs I put up in our department are “Caring, Clean and Courteous”.
My contribution was to note the three words beginning with C that I used to quote, for many years, to GP registrars at the end of an observed session of consulting. When worried about the exam I tried to encourage them that, as long as they Cared, had Curiosity and were Conscientious they would be good doctors. Why did I say this?
I wasn’t promising them that they would pass the exam on their first attempt. I wasn’t even promising that they would tick all the required competency boxes in the next twelve months. This was more about capability (when they need to keep learning), patient safety and future career satisfaction – maintaining enthusiasm and avoiding burnout. It was more about continuing professional development than measuring a good doctor in the here and now. More about attitude than current knowledge or skills.
About ten years ago I thought this off-the-cuff advice through in a bit more detail and with a bit more rationale to see where the options might lead. The powers that be want those finishing training to be competent. I took this as the starting point (at least as judged by various training assessments) and then looked at what might happen if they were also caring, curious or conscientious. My exploration produced a few more words beginning with C along the way. Perhaps a negative way to view this is to speculate on what happens if one of these attributes is not present. If you miss one of these things, it can all go awry. I guess I could have constructed the algorithm in a few ways but here is one version anyway (I’m sure you could come up with your own list to generate discussion).
I agreed with some of the tweeters that curiosity is essential. If you’re not curious you can stagnate. You might not seek out the new knowledge you need to manage problems, develop new skills or be intrigued by new presentations. If you’re not curious about the people you see every day you are at risk of boredom. You might still be caring and well liked but eventually you risk becoming incompetent without being aware of it. Perhaps this picture demonstrates curiosity along with a bit of tenacity!
If you are curious about medicine and about people you will never be bored.
If you aren’t conscientious, safety goes out the door. If you are conscientious you will keep up your professional development (regardless of any carrots and sticks) and you will follow up patients and ensure their safety. But without the curiosity and the caring this might become a soulless pursuit or even an anxiety ridden approach.
That over-used concept of caring
Caring is a bit of a vague (and over-used) concept but in some of its manifestations it modifies the other two attributes. If you care about the person in front of you, you will be more inclined to conscientiously follow up and be curious about what is happening to them. Caring can imply compassion for the person or passion for medicine and the profession. If you don’t care – you will find it difficult to develop a doctor patient relationship, you will lose interest and motivation to head into practice each day. A curious and conscientious doctor is likely to still be competent (and safe) in ten years’ time but they may miss some of the rewards of general practice that come with caring. If you care about people and care about your profession then you have motivation and passion that helps you hang in there.
Obviously, if you lack all three attributes things may not turn out well, regardless of the starting point, and I would acknowledge the growing relevance of collaboration (and perhaps collegiality) in the initial tweet. it should be somewhere in an expanded algorithm!
Here is where I add a “Caveat”. Will caring always make you more content in your career and help you avoid burnout? Not necessarily so. Problems with boundaries or system constraints that limit how you can help patients may cause frustration and burnout so these are things to bear in mind. You may be a good doctor for your patients but not for yourself! A discussion for another day.
The above is just a discussion that attempts to go beyond the current focus on measuring competencies to what keeps us going in a challenging career. In rapidly changing times we need to be capable as well as competent. The conclusion for me is that GP training and education should also focus on these other aspects. A training program should encourage and reward curiosity. It should recognise that sometimes a focus on ticking boxes and the often perverse incentives of quality frameworks can decrease the intrinsic conscientiousness that is part of professionalism. It should explore the importance and implications of caring and being compassionate. Perhaps this may also lead into the recognition of broader system issues that affect our ability to be good GPs and providers of effective primary care.