Last month, GP and the Kings Fund asked for your views on what makes a good doctor in the 21st century
…accurate and informed medical practice
A good doctor is still one who listens to the patients and helps them make sense of their experiences. The acknowledgement of where the patient is coming from and where the patient hopes to get to, and realistically can reach, is intrinsic to good medical practice.
The focus is entirely individualistic, and the values in play are only those of the doctor and the patient.
The basic duty of the doctor is to understand the patient’s values, without condoning criminal behaviour or immorality. The values of society are not present except insofar as they are brought in by either doctor or patient. The values of society in any case are multifaceted, largely unknown and variable, and so there are no yardsticks by which to measure an individual consultation.
Unjustified interference
The interaction between doctor and patient is based on duty, not utility, and so is only valid for that doctor and that patient. Interference from the outside world in the consultation is actually an unjustified intrusion.
There is no intrinsic demand that a consultation should serve any greater good for the community, only that it should help the individual.
The system exists to support the consultation-not the other way round. The fact that the current system is inadequate is regrettable. Both doctors and patients live in permanent disappointment over this situation, which benefits neither party.
Too many people want to be in the consulting room who have no right to be there. If ‘modern professionalism’ means accommodating them, then I do not want it.
I know what I should be doing in alliance with, and on behalf of, my patients. This is not paternalism; this is accurate and informed medicine practised to the benefit of my patients, with their negotiated concordance and consent.
For all the changes in medical regulation the fundamentals of good medical practice remain unchanged. These are listening to the patient, respecting the patient, diagnosing accurately, and doing no harm and some good with the treatment.
As a doctor I know what I should be doing. The challenge is for the politicians to understand where my duty lies and make it easier for me to deliver good medical care to my patients, who are also their voters. The interests of patients and doctors are as one here.
* Dr Peter Davies is a GP in Halifax, West Yorkshire. He has been invited to take part in a King’s Fund debate on medical professionalism
…continuing development and keeping up with NHS change
Trust, approachability and reliable, high-quality care are still key. However, these now need to be supported with a developing foundation of personal learning and development, encompassing evidence-based medicine, clinical governance and the need for change.
Modernisation challenge
Today’s politicised NHS is in a continuous state of change and modernisation. A good modern doctor needs to be informed and involved if they are to improve both the care they offer to patients and their own personal sense of achievement.
Modern medicine evolves at a furious and unrelenting pace, clinically and non-clinically. Today’s doctor needs to ensure that they can keep up with information on such changes from sources like the NICE guidelines, NSFs, evidence-based guidelines and local delivery plans.
They also need the skills to scrutinise this information for relevant details that can be introduced into daily practice.
This time pressure will only be acceptable if the modern doctor can welcome and support a wider group of healthcare providers with extending roles, such as nurses and pharmacists, while ensuring a level of governance and quality.
The future of healthcare is interwoven with good-quality IT. As a result, the GP must gain a clear understanding of clinical systems and the development programme for IT within the NHS.
However, the modern GP needs to remember that their work is not just about evidence-based, politically cultivated, financially rewarding care. We are the face of the NHS to most of the population, the first port of call when trouble presents, trusted and approachable.
Whatever else makes a good doctor in today’s society, these must still be core features.
* Dr Richard Jenkins is a GP in Chase Terrace, Staffordshire
…an ability to balance patients with politics
High standards are expected of today’s GP and, in order to deliver them, he or she will need to embrace the new situations thrust upon them in the face of changing healthcare.
GPs today are in a powerful position to become leaders within the NHS and to shape the future of general practice.
In order to attain the status of ‘good doctor’, GPs are developing certain attributes. The patient must remain at the centre of general practice and delivering high-quality care requires continual development and a meticulous attention to clinical practice and guidelines.
While doing this the doctor must still be able to elicit and address the concerns, whether physical, social or psychological, of their patients.
However, this is not the entirety of the GP’s role. With the advent of changes such as the new GMS contract and practice-based commissioning, GPs can play an important role within primary care organisations, advising them on what is important to their patients and in delivering community care.
The GP cannot shy away from the political agenda, but must face it and ensure the GP voice is heard.
The GP needs to be able to evaluate new ideas and ways of working and, if appropriate, explain and recommend them to colleagues in order for general practice to develop in pace with other areas of healthcare.
The GP is part of a team. The primary healthcare team is taking on an ever increasing importance under new GMS, while increasingly GPs must also forge links with other healthcare providers.
Within all this, in order to be effective, the GP must care for themselves, their own families and the welfare of their colleagues. Juggling work and family commitments is an increasing issue, and the ability to do this and derive support from others is essential for all GPs in today’s NHS.
* Dr Rachel Cooper is a GP in Benwell, Newcastle-upon-Tyne. She has been invited to take part in a King’s Fund debate on medical professionalism
…adaptability to change for better or worse
Today’s doctors have to please many different groups with varied agendas such as primary care organisations, government, patients, colleagues, employees and lawyers, to name but a few. The ability to reconcile these, at times, conflicting interests is one of the most difficult challenges.
Professional competence is clearly key. The advent of appraisal and accreditation has, in my view, established a clear means of demonstrating core competence and is not to be feared by the profession.
A caring attitude is vital and outcomes must matter. Good medicine today involves balancing patients’ wants and needs against resources, and a doctor must sometimes be prepared to disappoint patients and at other times to champion the individual.
Professional honesty is vital, to inform and protect patients and increasingly to protect one-self. Account must be taken of patients’ views and doctors must be honest about any mistakes.
A good doctor needs to be responsive to change, for better or worse. Responsible demeanour, personal and professional probity and moderation will continue to serve us well.
Good doctors are also made by good government, good leadership, reasonable working conditions and fair treatment by employers, patients, the law and the media.
* Dr John Inmonger is a GP in Blackpool, Lancashire
…a long-term, solution-focused approach
GP education needs to shift from being problem orientated to solution focused.
Giving advice or pills is not the way forward. Instead patients need to be empowered to develop their own physical and mental health. Ailments presented in the surgery are in general the result of stress.
Solution-focused brief therapy techniques, motivational interviewing techniques, building self-esteem and life coaching principles, on the other hand, are more helpful.
Through these the doctor helps to mobilise the resources of the patient and make the patient independent of the doctor.
A medicalised approach with pills will do the opposite. It encourages the patient to be dependent and to continue to frequent the surgery. Working in a solution-focused way is also more rewarding for the GP.
Such changes will benefit both patients and doctors.
* Dr Wouter Having a is a GP in Randwick, Gloucestershire
Have your say
GP still wants to hear your views on this issue. Write to [email protected], marking your response ‘King’s Fund’.
Dr Peter Davies: ‘The fundamentals of good practice remain unchanged’
A good doctor is still one who listens to the patients and helps them make sense of their experiences
Dr Peter Davies
GPs cannot shy away from the political agenda but must ensure their voices are heard
Dr Rachel Cooper
Dr Rachel Cooper: ‘The GP needs to be able to evaluate new ideas’
Good doctors are made by good government, good leadership, reasonable working conditions and \fair treatment
Dr John Inmonger
Acupuncture is one of the many therapies now available that may help patients find a solution to stress
Copyright Haymarket Business Publications Ltd. Dec 17, 2004
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