The best clinicians are driven by a passion for patient care, approach the practice of medicine with humility, and are as notable for empathy and curiosity as for core expertise, according to a study in the December issue of Academic Medicine that was released this week.
The qualitative study aims to tease out characteristics that outstanding clinicians exhibit in one of the world’s leading academic health sciences centres. “Our research team asked, ‘What makes a great doctor? Why do some clinicians stand out as the best of the best?’ ” says Dr. Sanjay Mahant. He is a SickKids paediatrician and project investigator in Child Health Evaluative Sciences, and an Associate Professor in paediatrics at the University of Toronto.
Best of the best
Widely recognized as a leading children’s hospital, and with 653 clinician-researchers working in every paediatric specialty, SickKids is a good hospital in which to ask these questions, adds co-investigator Dr. Anu Wadhwa, a physician and project investigator at SickKids and an Assistant Professor in paediatrics at the University of Toronto. “National bodies and medical schools put considerable effort into developing and defining competence. We were interested in the outlier – the clinician whose performance lies far above and beyond mere competence,” she says. “This study is among the first to ask clinicians to nominate the best of their peer clinicians, and in turn mine those individuals for their own insights and guiding principles,” she adds.
From the list of nominated physicians, more than a dozen were interviewed in depth. The themes that emerged in interviews included intrinsic motivation, humility, scholarship, reflective practice, people skills, clinical skills, engagement and adaptability.
The central importance of humility and people skills is a theme among all interviewees, and the nominated clinicians treat everyone – patients, parents, and all team members – with respect. “Our interviewees said that people skills are key to getting the most from the treatment team, and to the clinician’s ability to assess each child as a unique individual in a specific family context,” says Dr. Mahant. “Connecting with the individual patient and family is essential to the clinician’s ability to solve medical mysteries and support the patient and family throughout treatment.” Similarly, the top clinicians caution that technology cannot replace bringing a keen curiosity and love of patient care to engagement with the patient, he adds.
Put passion first
Quotes from the interview transcripts include:
- I really absolutely love doing patient care, and nothing that I do in terms of research or any of the other things I’m involved in give me the same satisfaction.
- You have to put passion first … your patients have to come first.
- The best clinicians love to solve problems … curiosity means that these people want to be involved, and love actually all aspects of the patient’s care.
- Just having the experience doesn’t make for excellence. It’s how you’ve learned from that experience that makes the difference.
- There is no place for arrogance in clinical care. The person who thinks they know it all – you’re dangerous. It’s time for you to retire.
- Common sense is terribly, terribly important. And we lose that sometimes in academics.
- We’ve become so focused on tests and on imaging as though that’s the absolute answer to everything. I would still hold on the value of clinical judgment.
- Independently I have to go and make my own assessment.
- Truly good clinicians never make a family or colleague feel that they are beneath them.
“To achieve the best care for patients and families we need to ensure that both the systems of care and the clinicians in the system are excellent,” says Dr. Mahant. “This study could help educators and leaders in medicine foster excellence, and trigger clinicians to reflect on attitudes, approaches and behaviours to achieve excellence.”
Follow-up studies could include observational and comparative studies of the distinguishing features of excellent clinicians in other settings, Dr. Mahant adds.
Funding was provided by SickKids Foundation and Paediatric Consultants Partnership at SickKids.
About The Hospital for Sick Children
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision of Healthier Children. A Better World.™ For more information, please visit www.sickkids.ca.
About SickKids Centre for Research and Learning
The SickKids Centre for Research and Learning will bring together researchers from different scientific disciplines and a variety of clinical perspectives, to accelerate discoveries, new knowledge and their application to child health — a different concept from traditional research building designs. The facility will physically connect SickKids science, discovery and learning activities to its clinical operations. Designed by award-winning architects Diamond + Schmitt Inc. and HDR Inc. with a goal to achieve LEED® Gold Certification for sustainable design, the Centre will create an architectural landmark as the eastern gateway to Toronto’s Discovery District. The SickKids Centre for Research and Learning is funded by a grant from the Canada Foundation for Innovation, the Government of Ontario, philanthropist Peter Gilgan and community support for the ongoing fundraising campaign. For more information, please visit www.sickkidsfoundation.com/bepartofit.
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The Hospital for Sick Children
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The Hospital for Sick Children