Becoming a Rural Doctor, Part 7: Ideal Professional Qualities

Over the last several posts in this series, I've discussed the training and education of future doctors. This week, I adopt a slightly different perspective and address some professional qualities I believe are important for all doctors to develop, no matter where their practice setting may be. In my experience, I've had to work especially hard at maintaining the following qualities when I'm on the job, because living and working in a small community tends to magnify a doctor's personal failings and can damage her reputation quickly indeed.

1. Patience

We all know patience is a virtue, but for some of us, it's a survival skill. My hospital uses paper-based charts and requisitioning (labs, radiology), and its staff tends to be young and not terribly well-paid, so several times a week a study won't get done or there will be some mistake and a test will have to be repeated. None of these incidents has ever resulted in a bad patient outcome, but the potential for harm exists and, in the meantime, my own efficiency is hampered by delay and incorrectly-obtained data.

I've worked in settings where institutional mistakes were greeted with yelling and carrying-on. I don't know if these behaviors actually improved delivery of services, but I do know they stressed everyone out and created a negative work environment, which opens up the opportunity for harm in other ways. My hospitalist group has gotten farther in advancing efficiency and appropriate testing by forming collaborations with the directors of lab and radiology, and with the technicians who have to run back and forth between Med-Surg and the ER and get the work done. No yelling.

I'd be lying if I said I never feel like blowing my top when I discover something hasn't been done ("OK, so what you're telling me is the abdominal CT ordered by Dr. Z two days ago never got done...And this happened because....?"), but I am telling the truth when I say I don't yell or carry on. It does no good to behave like an asshole. Far better to take a deep breath and pull the principles aside to review what went wrong.

2. Diplomacy

This is my great stumbling-point. I'm one of those awful people who tends to blurt out anything on her mind. Especially when I'm mad. This is one of those personality flaws to eliminate if you work in a small community hospital, where your choice of specialists is limited and you must collaborate with your consultants, even if you don't agree with them, because if you don't, then your patient doesn't get taken care of and it will be your fault because you couldn't play nice.

So I've been learning to bite my tongue and watch my tone of voice. For example, instead of saying "Have you lost your mind?" when I disagree with one of my colleagues, I'll say "I saw that you ordered an abdominal CT. Perhaps you were not aware one was done this morning?" Much more collegial. Much better for the patient, even if hard on my tongue.

3. Flexibility

After writing about patience and diplomacy, I suppose flexibility as a professional characteristic seems anticlimactic, but it certainly deserves its own mention. I find I need to be flexible in several aspects of my professional life:

• Working around hospital inefficiencies (see #1)
• Adapting to the practice styles and personalities of collaborating doctors (see #2)
• Being a good team member: if one of my colleagues gets sick, I'll take their call. If everyone wants to be off over Thanksgiving, I'll cover the holiday. I make my own demands on the team, and they cover for me. Medicine as a profession doesn't work unless everyone helps each other out.
• Communicating effectively with patients and their families: This one's important. Flexibility is really a tool for communication. Not only do you have to meet people where they are--physically, emotionally--at the moment you're talking with them, you also need to mirror their language and speak at a level they can grasp. I don't mean speaking down to patients; I mean tailoring your message so the hearer can understand what you're saying. This is a big topic and deserves a post of its own.

Without flexibility, professional life is unpleasant for everyone: yourself, your colleagues, your patients. This has been such a cornerstone in my working life, I'm amazed when I encounter someone who is really inflexible in their interactions with people. One or two of my colleagues fail the flexibility test, and it makes them poor team members, which is a tag you want to avoid.

4. "Unruffleability"

Some might prefer to call this quality level-headedness, but I don't find the term quite describes what I'm talking about. A level-headed person is practical, rational and not easily swayed by difficulties in everyday life--all excellent qualities in a physician. But what is the same person like under pressure? I would hope they would continue to exhibit these qualities, but this is often not the case.  The ultimate test of unruffleability is how a person behaves when the work day goes from routine to pandemonium in an instant.

This scenario happens in hospitals all the time. A Code Blue is called overhead, or a birth goes bad on Labor & Delivery. People are paged overhead and run to the emergency. How do they behave when they arrive? Do they bark out orders and yell at people, which only makes everything worse? Or do they quietly enter the room, take the situation in at a glance, and assume command? It's the latter person you want on your team.

Many levelheaded people are unruffleable, too, but you don't know until you've seen them in a crisis. If you're in training as a student or a resident, learn from the unruffled attending physicians. One day you'll be the person who shows up and keeps her head about her when all around her are losing theirs--and we'll all be grateful to you.

There are so many other professional qualities important in a good physician, but the four I've discussed above come up again and again. They've truly separated the wheat from the chaff in my professional life. What else would you add to the list?

Comments

[Kim]

Amen. I'm reading through your archives and have been trying to hold in my comments until I'm more current, but had to respond to this. I'm a social worker in a large, tertiary care hospital--and this post, particularly the pieces about flexibility in communication and unruffleability, totally hits the nail on the head.
Also, I'm in career transition to become a CNM and am LOVING your birth stories and the series on childbirth philosophy.

[Samantha]

For me, another good quality would be the ability to work well with the people beneath you. I have spent four years as an administrative person in a military hospital, and that experience taught me a lot about how to interact with everyone. Just because you outrank me/have more experience doesn't mean that you need to talk to me like I have no idea what's going on. I can read charts, and I am probably the one that processed the admissions paperwork. I'm asking questions because I want to know the answer to store it for future use, so that if this happens again, maybe I can be standing there with paperwork all ready to go, or the room prepped for whatever, or just relay something correctly. Maybe I'm wrong in my assessment, but doesn't everyone within the clinic or the ward contribute to a good working environment? Obviously, there's only so much that I can do, as I'm not a nurse or doctor, but if it's a busy day, doesn't every little bit count?
Then again, when I started to leave this comment, I meant that if you're higher on the ladder than someone else, don't talk down to that person. The little guy might know something you could find helpful.

[alexa-blue]

I believe the term is aequanimitas

http://www.medicalarchives.jhmi.edu/osler/aequessay.htm

[KP]

You HAVE to become attending and teach your wisdom to med students, residents. Instead of those ivory tower geeks who care more about research. I have learned more from reading your blog than I ever from any of my attendings save one.