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How to be good
[It’s one thing to be good at your job, but what does it mean to be good in your job? The writer Francis Spufford recently explored this thought-provoking question in a series of conversations at Ely Cathedral, with people from a variety of professions. These extracts come from his discussion with Harston resident Professor Rebecca Fitzgerald, who works in cancer medicine.]
To be a good doctor, it seems to me, is to put the patient absolutely at the centre - it is not just about the disease. The world of cancer is increasingly high tech and the diagnostic tests that we do are complex and often involve not just scans and biopsies, but also understanding what is going on in a molecular level of detail. Often, we no longer pick a standard treatment for a specific cancer type but design a tailor-made set of treatments depending on the characteristics of the tumour. Yet the expression ‘personalised medicine’ makes me wince because what is medicine about if it is not personalised? Medicine is a blend of art and science. There is no ‘one size fits all’ solution. A ‘good’ doctor needs to go beyond a technical assessment of the disease and to have an acute diagnostic sense of what humanly matters to that person - their hopes and fears and their social context.
When I see a patient in the clinic, I have all the technical details of their case to hand, so I have a mental picture of the problem. But until I call that patient from the waiting room, I can’t fully evaluate the patient. Until that moment the patient is a stranger. The consultation is a deep and personal encounter. Usually there is no one else present apart from you the doctor and the patient, with any loved ones or confidante that they choose to accompany them. If invited to do so they will tell you about their deepest concerns and longings. In a consultation about cancer the patient may literally be facing the reality of death for the first time. They might want treatment at all costs, but they might not. I saw a patient recently with advanced cancer who explained that the thing that mattered most was being strong enough to attend her son’s wedding - this meant making a new plan. It wasn’t about following an algorithm any more.
As a good doctor the patient encounter is an act of loving kindness. This is much more active than ‘do as you would be done by’. I was doing an interview for a consultant post at Addenbrooke’s and the lay member of the panel turned to the doctor being interviewed, and said “and are you KIND, Dr Smith?” There was no evading the question. It wasn’t about being technically competent, or being nice - it was about a deeper response.
All this requires insight, experience and confidence - to put aside the rule book at times and to meet the needs of the person. To put the science of medicine into the context of what humanly matters to that person at that time in their lives. That, I think, is being a good doctor.
Videos of Rebecca’s interview and others in the series can be found on the Ely Cathedral website.