You only die once

Chapter 10 Are you the best doctor?

Chapter 10

Are you the best doctor?

Fancy getting asked that question. I was a bit taken aback. This was after a long counselling session with a cancer patient. I recollected my thoughts in seconds and said cheekily, "I don't know. I am just an available doctor."

A friend asked me to recommend a doctor for him in a different specialty and I said this surgeon is the one I would choose. At the same time, I warned him that the doctor is quite nasty with his words and seldom shows much compassion but he is the most competent one with the best hands for that surgery. You have to ignore his nasty comments.

So the question I have been reflecting on is what makes a doctor 'good'. My thoughts centre on three aspects plus one.

The first is the intellectual part. This is about knowledge. Acquiring it, remembering it, and understanding it. What you would generally refer to as the 'brainy' doctor.

Second is the application of this knowledge. Putting it all together to solve a problem or deduce a diagnosis. The 'reasoning' part.

Third is the skill of the doctor. The hands of a surgeon. The skill of the physician in procedures like angioplasty. The anaesthetist that can intubate even without a scope.

And the plus one is the emotional part. Doctors unfortunately are only human, not Gods or even the apostles. Thus, they do get upset at times or many times, or all the time. And sometimes emotion ends up in the decision. Hopefully as rare as possible.

The emotional part is also the compassionate part. How do you tell a patient that he would die? How would you counsel the family? What 'mask' do you put on and when? Or you are the one who gives the facts and says "take it or leave it"? And is your approach always the same with everyone or do you vary it according to the person's intellectual ability, upbringing, and expectancy?

I would say I am deficient in some aspects at some time or other. Hopefully not commonly. Seldom can you truly self-judge yourself.

As a doctor, we try to be the best we can in each of these parts.

And frankly, how does a patient choose a doctor? A relative of mine said to me that that doctor must be the best doctor in this hospital. I asked why and he replied, "He has a title, his list of degrees is four lines." Interesting isn't it? Little did he know (or even me when I was not a specialist yet) that if you pay money and have the minimum qualifications, you can be given 'that' behind your name. To be fair, some you really need to struggle to get them. Does it matter if he is a physician with recognition from one country or two or three, or has a title?

So when I choose a doctor for someone, the three plus one aspect comes in play. If it is a diagnostic problem, then the first two are very vital. If it is a procedural thing like putting in a stent, you want the one who can do it safely and well. If it is a real diagnostic problem, then the most important is number two. And hopefully, the doctor is also humble enough (emotional part here too) to refer or consult others if it is beyond him or her.

Hopefully, we as doctors can recognise our shortcomings and address them as best as we can. As we graduate, train and self-train and retrain, we become different over time. Our experiences mould us and we become different.

I am no longer the doctor I was when I was 30. Over the years, I realised my ability to reason and diagnose has improved and I have become much more confident (rightly or wrongly) and bolder in my decisions. Yet I hope I am more aware of my deficiencies and refer or consult when there is a need.

Lastly, there is this belief of mine that, in medicine, as you train and learn, then suddenly over a short period of time, be it a day or a few weeks, it 'clicks' and the 'brain' part connects in an exponential curve to the 'reasoning' part and suddenly you become 'good'. Then another level is attained and you become even better and you peak. This the same as driving. The first few lessons you seldom get it right. Then you can drive. Then a few lessons later, you have become an 'expert'. Something clicked.

The sad part that I hope I will know and have to acknowledge soon (as I am ageing) is that I cannot keep up with the first (intellectual) part, which will affect the second part (reasoning). I hope when the day comes, I know how to 'get off the stage' gradually.