Best of The Cheerful Oncologist: "Good Doctors Leave Good Tracks"

[Editor's note: this essay is adapted from a post first written on December 16, 2004)

The most influential mentor I ever had, who taught me how to chase and capture excellence in all aspects of patient care, and why giving one's best is the only goal worth pursuing in medicine, once told me that he had discovered a way to measure the merit of a doctor. He said, "Good doctors leave good tracks," by which he meant that one can always identify exceptional physicians by the "trail" of evidence they leave behind after their work is done - a ship's wake, if you will, that represents the effect they had on the patient's life, a trail that does not always guarantee a healthier patient but does show the world the type of doctor who captained the mission. Just as different vessels leave different wakes behind them, certain bits of evidence reveal the depth and worth of the doctor's effort. The converse of this saying is just as true: "Lousy doctors leave behind evidence of lousy work."

With a little training anyone can become an expert in deciphering the tracks of doctors just by examining the trail they leave behind at the end of the day. In my opinion these are the marks of distinction:

The Written Word. There is no easier way to separate good and bad doctors than by the dictated reports, handwritten orders and notes, and letters they produce. Good doctors have legible handwriting, no matter how much of a hurry they are in. They take the time to document the important facts of a patient's illness and the information relayed to the patient. Counseling sessions are put into the written record: the risks, possible side effects and alternatives of a treatment. The medical record should be clearly documented as if a new doctor could pick up the chart the next morning and take over the case with ease.

The Spoken Word. A good doctor speaks clearly and respectfully, avoids medical jargon and slang, shuns a prejudicial attitude, never assumes that one attempt at explanation will be sufficient, nurtures assurance and hope in a time of dread and uses humor like an ice cream vendor on a hot summer day. Great doctors use verbal communication as the best way to destroy fear, ignorance and despair.

Critical Thinking and Investigation. Good doctors never assume that a patient's symptoms are due to the same run-of-the-mill maladies that they see day after day. They excel at what is called lateral thinking, or thinking "outside the box" of routine illnesses. They ask themselves questions, such as "Do I have the right diagnosis?" and "Do I really understand what is happening to my patient?" They order tests that best fit the patient's clinical presentation. When they are stumped, they research the question until they are satisfied they have filled in the missing pieces of the medical puzzle. They ask experts for advice. Good doctors are always smarter than they were the week before.

Following-Up. Lastly, it is tedious but vital that doctors review the results of all the tests they order, that they keep in contact with sick patients, that they double-check their plan of attack for an illness and stay knowledgeable with current medical news and developments, that when matched against such villains as cancer they never assume anything but stand at the helm, ready to change course at the first sign of a troubling sky.

No other career combines the dual responsibilities of academic study and human contact as magnificently as medicine. As Sir William Osler said, "To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all."

Each morning physicians set sail into the vast blue sea of medicine on a voyage to bring their patients home safely, their eyes scanning both the horizon and the sky. By watching the foamy trail left behind we can determine which doctor is the right skipper for the journey.