Embracing and Affirming the "Good" Doctor

Contributors:  Linda Roszak Burton, ACC, BBC, BS and Betsy Chapin Taylor, FAHP
To learn more about Linda and Betsy, click here.

 

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This is the second in a series of articles that calls upon the importance of values and virtues as part of a model of Virtuous Practice to improve physician well-being and strengthen patient relationships, resulting in patient satisfaction, loyalty, and continuity of care.

Physicians face unrelenting pressure in the current care environment where throughput, profit, and integration of technology hang heavy over all clinicians and sometimes inadvertently strip the humanity from a patient encounter. Further, 47% of physicians report multiple symptoms of burnout, emotional exhaustion, and loss of joy in work. (Medscape, Physician Burnout & Depression Report 2022: Stress, Anxiety, and Anger, Leslie Kane, January 21, 2022)

Meaningfully and proactively addressing burnout is vital to restoring physician well-being; therefore, it's imperative to understand proven antidotes to prevent and ease burnout. Addressing pervasive system issues — such as excessive workload, underutilization of non-physician practitioners, and alienation caused by use of technology — can be a wicked problem. However, harnessing the power of values and virtues through an approach Accordant calls Virtuous Practice can offer an accessible and effective healing salve for healthcare's open wounds by creating mutually rewarding physician-patient relationships and by fulfilling patient expectations of a "good" doctor.

Deepening the physician-patient relationship can provide a significant lift to both. Research demonstrates the significance of several values-focused relational elements as pathways to strengthening physician well-being. These include:

  1. Receiving expressions of patient and family gratitude
  2. Experiencing compassion satisfaction
  3. Forging relationships rooted in connectedness and belonging
  4. Restoring purpose and meaning in work

Research from multiple scientific studies validates the elevating effect of clinicians receiving expressions of gratitude from patients and family members. Studies show receiving gratitude increases well-being, increases a sense of personal accomplishment, increases team performance, decreases emotional exhaustion and decreases burnout.1 Further, gratitude received directly from patients is far more impactful than receiving gratitude from other clinicians or from healthcare executives, so there is value in considering what sparks patient gratitude.2

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Patient gratitude is not dependent upon achieving positive clinical outcomes. There are multiple antecedents to patient gratitude — and most must be nurtured not forced. Gratitude in the care environment begins when a clinician anticipates, recognizes, and responds to a patient or family member’s needs, wants, or concerns. This “perceived benefactor responsiveness” is a “significant and strong” predictor of gratitude.3 Additionally, benefits received by the patient must exceed one’s social expectations of others as well as what one feels they earned or paid for; for example, a patient expects a physician to provide her with an appropriate diagnosis and treatment in exchange for providing insurance or payment to receive care. However, a physician can exceed a patient’s expectations through addressing emotional and social dimensions of care that make one feel understood, validated, or cared for. Finally, the recognized “goodness of the giver” increases the likelihood of experiencing gratitude; this hinges on the perceived effort and intentions of the physician rather than the physician’s expertise or credentials.4

Given the importance of a physician’s perceived efforts and intentions as a prerequisite to gratitude, there is merit in considering what patients perceive as the characteristics or commitments of a "good" doctor. Patients have a baseline expectation that a physician has appropriate medical knowledge and experience; competence is table stakes. However, dozens of studies indicate patients consistently prioritize quality of interpersonal relationships between the patient and physician that reflect an inherent value for human beings and the validity of shared human needs. For example, patients want a physician to identify them by name, know them as a person, and show sensitivity to their emotions. Beyond simple recognition, patients repeatedly prioritize five specific relational behaviors reflected in the Virtuous Practice model.5,6,7,8,9

  1. Love for people demonstrated through compassion and respect
  2. Kindness reflected through friendly, cheerful rapport that puts patients at ease
  3. Listening that is attentive and aims to understand
  4. Communication that is clear, understandable, honest, and polite
  5. Presence showing one is engaged, interested, attentive and available

It is worth leaning in around “love.” This is clearly not about romantic love, but, rather, humanistic love of humankind. It is love without a need for self-benefit or return of affection. This form of love is often demonstrated through compassion and respect, and it is a linchpin of attachment that enables a patient to feel safe, appreciated and connected to the physician.8  

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Patients indicate experiencing love, compassion, and respect is vital to exceptional care, and research demonstrates the link between love and improved clinical outcomes as well as increased trust, connectedness, satisfaction, adherence with care instructions, and continuity of care.5

When physicians demonstrate the intentions of a “good giver” and fulfill patient expectations of a “good doctor” through love, kindness, listening, communication, and presence, the behavior provides a catalyst for restorative patient and family gratitude. In addition, positive physician-patient interpersonal relationships provide other substantial benefits to physicians by facilitating compassion satisfaction, deepening connectedness, and restoring purpose in work. Compassion satisfaction is contentment and joy that results from helping others and that facilitates resilience and counteracts burnout.10  

Physicians who advance Virtuous Practice also experience a greater sense of human connectedness that affirms purpose in their work — and experiencing meaning from purpose-driven work serves as a “significant protective factor” against burnout.11,12 Ultimately, demonstrations of love, kindness, listening, communication, and presence set a virtuous circle in motion. When physicians consistently foster positive interpersonal relationships with patients, it creates a variety of halo effects to support physician well-being and joy in work that in turn inspire the continuance of high-quality relationships.13

Physicians authentically and routinely embracing a Virtuous Practice model that includes love, kindness, listening, communication, and presence consistent with patient perceptions of a “good doctor” not only leads to gratitude, compassion satisfaction, and other enablers of physician well-being but also upholds the ideals and sacred trust inherent in the noble profession of medicine. 

In future articles in this series, we'll further unpack the importance of compassion and expand on the ideals of Virtuous Practice.


Contact Linda at: [email protected]
Contact Betsy at: [email protected]


References

  1. Converso D et. al. “Do positive relations with patients play a protective role for healthcare employees? Effects of patients' gratitude and support on nurses' burnout.” Frontiers in Psychology vol. 6 470. 21 Apr. 2015, doi:10.3389/fpsyg.2015.00470.
  2. Riskin A et. al. “Expressions of Gratitude and Medical Team Performance.” Pediatrics vol. 143,4 (2019): e20182043. doi:10.1542/peds.2018-2043.
  3. Algoe SB and Stanton AL. “Gratitude when it is needed most: social functions of gratitude in women with metastatic breast cancer.” Emotion (Washington, D.C.) vol. 12,1 (2012): 163-8. doi:10.1037/a0024024.
  4. Watkins P. (2014). Gratitude and the Good Life: Toward a Psychology of Appreciation. doi:10.1007/978-94-007-7253-3.
  5. Schattner A. “Can Humanism Be Infused Into Clinical Encounters in a Time-Constrained, Technology-Driven Era?” Cureus vol. 14,8 e27836. 9 Aug. 2022, doi:10.7759/cureus.27836.
  6. Borracci RA et. al. “What patients consider to be a 'good' doctor, and what doctors consider to be a 'good' patient.” Revista medica de Chile vol. 148, 7 (2020): 930-938. doi:10.4067/S0034-98872020000700930.
  7. Steiner-Hofbauer V et. al. “What is a good doctor?” “Was ist ein guter Arzt?/Was ist eine gute Ärztin?” Wiener medizinische Wochenschrift (1946) vol. 168,15-16 (2018): 398-405. doi:10.1007/s10354-017-0597-8.
  8. Shippee N D et. al. “Effect of a Whole-Person Model of Care on Patient Experience in Patients With Complex Chronic Illness in Late Life.” The American Journal of Hospice & Palliative Care vol. 35, 1 (2018): 104 -109. doi:10.1177/1049909117690710.
  9. Surveys of Trust in the U.S. Health Care System, American Board of Internal Medicine Foundation, May 21, 2021, p. 20. https://buildingtrust.org/wp-content/uploads/2021/06/20210602_NORC_ABIM_Foundation_Trust-in-Healthcare_Part-23.pdf.
  10. Burnett HJ and Wahl K. “The Compassion Fatigue and Resilience Connection: A Survey of Resilience, Compassion Fatigue, Burnout, and Compassion Satisfaction Among Trauma Responders.” International Journal of Emergency Mental Health and Human Resilience 17 (2015): 318-326.
  11. Fricchione GL.” Separation, Attachment, and Altruistic Love: The Evolutionary Basis for Medical Caring,” in Stephen G. Post and others (eds), Altruism and Altruistic Love: Science, Philosophy, and Religion in Dialogue (New York, 2002; online edn, Oxford Academic, 22 Mar 2012), https://doi.org/10.1093/acprof:oso/9780195143584.003.0030.
  12. National Academy of Medicine. Taking Action Against Clinician Burnout: A Systems Approach to Professional Well-Being (2019).  https://nap.nationalacademies.org/catalog/25521/taking-action-against-clinician-burnout-a-systems-approach-to-professional, p. 84
  13. Layous. K, Nelson SK, Kurtz JL, and Lyubomirsky S. (2017). What triggers prosocial effort? A positive feedback loop between positive activities, kindness, and well-being. The Journal of Positive Psychology, 12(4), 385–398. https://doi.org/10.1080/17439760.2016.1198924.