Helen Jaques asks what makes a good doctor?

Helen JaquesBack in 2006 the British Medical Association asked almost 1,000 doctors what core professional values were most important for the practice of medicine, and the respondents came up with all the “C”s: competence, caring, compassion, and commitment.

According to a new study in the Journal of Medical Ethics, however, another “C” needs to be added to the list: cheerfulness.

Geniality—being cheerful, friendly, or sociable—came out as the top attribute of a good physician in a study of more than 100 Turkish medical students. On the other hand, traits covering scientific knowledge and medical practice—such as professional competence and perseverance—came out bottom.

The authors of this study asked a group of 127 first year medical students to write down and discuss the “attributes of a good physician.” The students came up with a total of 756 attributes, which were then grouped into four broad categories.

The “interpersonal relations and communication” category had the most entries (n=413 (54.6%)), with the individual traits of geniality, being able to communicate well, humaneness—“treating patients as human beings not as robots of pieces of meat,” said one student—and benevolence being the top four characteristics overall.

The category “sustaining professional integrity,” such as by “behaving in a way that inspires respect for the profession” and “treating everyone equally,” had the next highest number of entries (n=133 (17.6%)), whereas the “sustaining personal integrity” category, which included the ethereal concept of “being a good person,” was third (n=112 (15.5%).

Surprisingly, “scientific knowledge and medical practice” category had the least number of entries (n=98 (12.3%)), although open-mindedness was 8th most popular trait overall. Being “hardworking,” “able to think scientifically,” or “clever” were each mentioned by fewer than 10 students.

A similar study carried out with faculty, residents, medical students, and patients in the departments of family medicine and paediatrics of a hospital in the US state of Georgia found that compassion was the top “character virtue” expected of doctors.

The other two big areas necessary to maintain professionalism were “knowledge/technical skills”—being “up to date” and “knowing their stuff”—and “patient relationship”—“treating people the way you want to be treated.”

Although both the Turkish and the US study found that communication was valued highly, the US participants didn’t mention social justice, whereas the Turkish students placed great emphasis on being fair.

But why are people so concerned about the personality attributes of doctors? Well, compared with other professionals, doctors have a quite unique relationship with their “customers”—their patients.

As the Royal College of Physician’s report Doctors in society: Medical professionalism in a changing world points out, “Medicine concerns the experiences, feelings, and interpretations of human beings in often extraordinary moments of fear, anxiety, and doubt. In this extremely vulnerable position, it is medical professionalism that underpins the trust the public has in doctors.”

So what does this mean for doctors? Can these personality characteristics be instilled throughout the course of medical training, or, as one of the participants in the Georgia study said, “you can dress people up, but you can’t make everyone a doctor”?

Medical educators prefer to go with the latter, and much effort has gone into trying to pinpoint the core characteristics that make someone a good doctor and instil said values into medical students. Medical bodies such as the Royal College of Physicians and the General Medical Council, for example, have analysed the importance of the behaviour of doctors in countless working groups and reports on professionalism.

Luckily most of the characteristics highlighted by the Turkish medical students link well to the objectives in the Turkish medical school curriculum and the learning objectives for medical education from the Association of American Medical Colleges, so it seems that the efforts to instil professional values seem to have worked pretty well in this bunch of undergraduates.

• For more on teaching and measuring professionalism, see:
Engel N, Dmetrichuk J, Shanks AM. Medical professionalism: Can it and should it be measured? Student BMJ 2009;17:b4455

Helen Jaques is a technical editor for the BMJ