What's a good doctor, and how can you make one?

By marrying the applied scientist to the medical humanist I remember the time Shipman gave to my Dad. He would come around at the drop of a hat. He was a marvellous GP apart from the fact that he killed my father. 1 A re you a good doctor? This question is increasingly being asked by patients, governments, third party healthcare payers, and newspaper, radio, and TV investigators. It also topped the list of suggestions for BMJ theme issues in a recent ballot of bmj.com users and BMA members. But why? Claims and complaints against doctors are growing worldwide. In the United Kingdom, a series of inquiries has ushered in probably the most sustained investigation and collective appraisal of medical and healthcare institutions since the NHS began. The performance of individual clinicians, laboratory and clinical units, the frequency of medical mistakes, the unacceptability of organ retention practices, and the adequacy of death certification procedures are only a few of many medical activities now subject to intense scrutiny. 2–8 A debate has thereby been prompted about the sort of doctors society wants and expects, and the need for answers is heightened by expansion in spending on medical education and health services. One approach to defining a good doctor equates the answer with the skills of an applied scientist: good doctors combine individual clinical expertise and best available external evidence; they are thoughtful, evidence based practitioners who use " intangible personal resources " in the care of their patients. Another approach lies buried in the Socratic dictum " Know thyself, " an exhortation discernible in the importance the General Medical Council attaches to vocationalism in medicine and to the personal qualities required of its practitioners, including truthfulness and a reflective turn of mind open to audit and to learning from mistakes. Readers from 24 countries responding to a BMJ debate about what makes a good doctor allude to desirable personal qualities more prominently than proficiency in knowledge and technical skills (p 715). The psychiatrist Jeremy Holmes, writing in this issue (p 722), renders Socrates' dictum in a more modern , psychological form by acknowledging that the inner life of most doctors necessitates grappling with contradictoriness and incoherence of thoughts and feelings. If this state of affairs is the norm, reflecting on good and disapproved of aspects of the self will help doctors to become " good enough " practitioners. But the proliferation …