How To Know If You Are A Good Doctor?

Dr. Sara Dill: I’m Dr. Sara Dill, and this is the Stress-Less Physician podcast, Episode Number 35. Welcome to the Stress-Less Physician podcast, I’m your host, Dr. Sara Dill, MD. Using my unique combination of coaching and mindfulness tools, I will teach you practical ways to reduce your stress level, feel happier at work and create a better balance between your medical career and personal life. If you are a busy practicing physician who wants to design a life and medical career that feel good to you, you are in the right place.

Hey everyone, welcome back to the podcast. It’s fun to talk to you. I wanted to talk about this subject today about: “How Do You Know If You’re a Good Doctor?” And I’ve been thinking about it because it’s something I coach on a lot, and I think it makes such a difference in how we feel about our work, our patients. Really a lot of how we spend our time is really colored by whether we consider ourselves good at what we do. Good as a physician, and even good as a parent, good as a spouse or partner, good as a friend, right? All of it. Do you think you’re doing a good job at whatever it is you’re doing? And I just want to start by reminding you that you get to decide.

Like often, I’ll start by asking clients like, how do you know? Who gets to decide if you’re a good doctor? So, just really thinking about that. Do you think that you are the one who gets to decide if you are doing a good job as a physician, or do you think that it comes down to how other people think of you, right? Are other people deciding? Or do you think that somewhere out there—sometimes, I think about this—do you think that somewhere out there there’s just a list of who’s doing a good job as a physician? And you don’t really know how to get on that list, on how to decide, right?

So, if someone asked you, are you a good doctor? What would you say? How do you decide? Do you realize that you are the one who gets to decide that? It’s a thought that you get to think. And what are your metrics? How do you know if you’re doing a good job or not at anything? But specifically, I want to talk about how do you know if you’re doing a good job as a physician?

And like I just mentioned, this is the same idea for any role or any job or any identity you have. So, if you feel you’re good at being a doctor, as a physician, or maybe you aren’t a doctor and you’re still listening to this podcast, do you feel you’re doing a good job as a parent, as a spouse or a partner as a son or a daughter, as a brother or sister or sibling or friend? Again, you get to decide how do you think of how you’re doing and what are the metrics that you use to decide that? Are they helpful? Are they useful? And do you want to keep using them?

So, for a lot of us, how we decide if we’re a good doctor or a good enough doctor, or maybe we feel we aren’t good enough. Typically, what I hear a lot of—and I’ve certainly done this as well—is use metrics like if patients like us, right? So, are you using patient popularity, right? Or whether patients tell you like, “Oh, you’re such a good doctor, right? I really appreciate you.”

So, appreciation or being liked by our patients, are you using that to decide that you’re doing a good job? One of the most common things I think that we do as physicians, and it sort of makes sense, is deciding that we’re a good doctor if our patients improve or get better or maybe don’t die, right? Or if you’re in palliative care, maybe you decide that you’re doing a good job based on how patients die or how they navigate through their illness. In this case in general, regardless of what kind of physician you are, whatever specialty you’re in, right? Are you using patient outcomes as a way to assess your performance as a physician?

Maybe you’re using whether or not you get good online reviews, maybe you are using whether your staff likes you, whether they tell you if you’re doing a good job, maybe you are relying on your salary or getting promotions or your job title, maybe you are comparing how you seem to be doing to your colleagues. Are you working as hard as they are? Are you saying yes to as many things? Do you publish as much as your colleagues? Are you on committees like your colleagues?

Again, I will just note, and I know I’ve referred to this before, but often when we compare our internal narrative, our internal experience of ourselves, our thoughts, our doubts and our fears to other people’s external image, public image or their outside sort of appearance. It’s probably never going to be a really true or useful comparison. Typically, it makes us feel not good enough.

So, just notice if you’re doing that, right? Are you trying to compare yourself to others as a way to assess whether you’re doing a good job as a physician? And then maybe you are using how you do on examinations or tests or MOC or something like that as a way to assess whether or not you are a good doctor or a good anything.

And so, if you are a parent, you could notice if you have similar metrics, right? Do you decide that you’re doing a good job as a parent based on how your child does in school? If they have friends, how they’re doing in life, right? If they’re happy, if they seem like they are going to turn out successfully or maybe, are they successful? What does successful even mean to you? What are those metrics? So, just noticing again, how are you deciding, how are you grading the job that you’re doing as a physician, as a parent, as whatever else, whatever role is important to you?

And do you see the problem with these kinds of metrics, with this way of grading ourselves or with this way of deciding that we’re doing a good job as a doctor or that we are a good enough doctor? Or maybe an excellent physician. How do we know? How do we decide?

So, the problem with this is it is totally outside your control. So, if you are trying to assess how you’re doing as a physician and you’re using any of these metrics, you have no control over that. I mean, you might be able to influence some of these, but you cannot a hundred percent determine the outcome, you cannot control them, no matter how much effort you put in. You cannot ultimately control whether patients like you, whether you get all good reviews, whether patients get better or improve or have outcomes that are positive in some way. You can do your best. You can follow every guideline, you can prescribe all the right medications to exactly the right surgery, and sometimes patients don’t have positive outcomes. Sometimes patients don’t get better, sometimes they don’t improve, and sometimes they die.

You cannot control a hundred percent, your salary, your promotions, your titles. You can strive for them, right? You can ask for them, you can go after them certainly, but you are not the final arbiter of that. You cannot control how you compare to your colleagues. And in fact, a lot of the time when we compare ourselves to our colleagues, we’re comparing ourself with things that we don’t actually want to do.

Maybe you don’t want to write a bunch of papers, maybe you don’t want to be on a bunch of committees, but are you using those metrics against yourself? Same with how we do on exams or maintenance of certification. You can study and do your best, but in the end, those are outside metrics, those are circumstances, those are not under just our control. So, if that is how you decide you are a “good doctor,” you’re pretty much going to be screwed at some point, honestly, because again, we can’t always control that, if we’re relying on other people, their thoughts and emotions and other results that are not a hundred percent under our control, right? We can’t then really control whether we meet our own metric of how to be a good doctor.

And what I find—this is what I sort of notice for myself—if you are using metrics that are outside your own control, and especially if you’re relying on what other people, patients, etc, think of you. You might find yourself doing what I call tap dance. It’s this sort of sensation of tap dancing desperately in front of people like patients, patients’ family members, staff, etc, to like you, to approve of you, to try to get patients to do what you are telling them to do and to use what you are prescribing for them, to try to make sure patients get better.

Do you feel like you’re tap dancing, right? Sort of performing for other people to gain their approval, right? And do you feel like you’re doing a good job? Typically, that just makes us less effective, I found as physicians. So, it actually often ends up making, at least for myself and for a lot of my clients, sort of show up not quite as the doctor we want to be.

So often, one sign of using outside metrics to decide how you’re doing as a physician is a really heavy sense of over responsibility, almost of over caring. So, you can ask yourself, do you feel responsible for how your patients do? And in particular do you feel more responsible for how they do more than they do? Do you feel it’s more your responsibility than their responsibility? Do you care more about your patient’s health and outcomes than they seem to? That’s a sign. You’re probably using their outcomes and their opinion of you to assess whether you’re doing a good job as a doctor, and it will feel like this heavy burden.

This sense of responsibility and caring that feels heavy. And that’s because we can’t care more than they do, right? In the end, how patients do is up to them and also up to a host of factors beyond anyone’s control sometimes, right? Genetics, accidents, lots of things. So, of course, we care, right? Of course, we want patients to do better and get better, and of course, we want patients to like us. That is totally normal and universal. And in fact, I would worry if we didn’t care at all, right? That’s probably a sign of burnout.

But I would argue that we can’t or that we shouldn’t rely on those things to use as evidence for our being a good doctor, for our being a good enough physician, for our being the best physician we can be, for how we decide to think about how we’re doing. For that, we need to consciously choose measures that we can control a hundred percent.

So, I want you to start to think about this. What are some metrics that we could choose consciously, that we can use as sort of a standard for measuring how we’re doing and how we’re showing up as a physician, for if we are being the best physician that we can be, if we’re showing up as the physician that we want to be.

So, I want you just to start to think about that, can you think of any. I can tell you some of my metrics, and I will also say sometimes I fall a little short. So, on the one hand, you want to pick ways of assessing how you’re doing as a physician or as a parent, as a friend, as a partner, as whatever that you get to control, and then we also get to grade ourselves, right? So, there’s sort of two parts to this.

So, my metrics, my first one and the big one really, is to do my best to do no harm, right? To the best of my ability, to certainly not intentionally do any harm and to really try to minimize any mistakes or errors, any unintentional harm, and to take responsibility for all of it. So, this includes making sure that I’m asking for help, that I’m getting second opinions, that I’m doing more research, that I’m referring patients, whatever I need to do to make sure I know what I can manage on my own and when to refer, when to get more information.

So, I think all of us most likely see patients with diagnoses that are unclear or challenging, difficult. Maybe we don’t know. And so, I do think that for me, being a good physician means staying up to date on the literature. To the best of my ability, doesn’t mean reading every single article, right? But staying up to date with the literature. It means knowing what I don’t know and admitting it and taking steps to figure stuff out.

So, I often tell patients like, “I’m not sure exactly what you have, but this is what we’re going to do to find out.” Maybe we do a biopsy, maybe I order some blood. Often, I’ll go back to the literature, I’ll do a quick literature search, I’ll review some other things, right? I have a plan and then I have a plan as we move along, and I’m honest about that. So, making sure I know what I do know and making sure I also know how to enlist other experts and when to refer. I also assess myself as a physician by making sure I show up as my best self at work. And also, this involves coaching myself a lot rather than requiring patients to follow my own manual for them.

And I know I’ve talked about this earlier in some podcasts. You can go back and listen to the podcast episode I did on difficult patients and also the one on the manual, right? On my rule book for how patients should show up. So typically, those are my rules, right? I should not get angry, I should respect my time and their time. I have a whole list of things. So, am I showing up as my best self at work? Am I not bringing my personal issues into work or into the doctor-patient relationship? So, doing my work first on whatever’s challenging me.

I also do my best to not take other people’s behavior personally, especially patients, right? I’m allowed to have boundaries. I do have boundaries, but can I enforce whatever those boundaries are with humor or affection, rather than anger or frustration or resentment.

So, if a patient doesn’t like me, or if a patient disagrees with what I’m recommending can I actually hear them? Can I have that as a conversation? Can I respect that they don’t have to agree with me? Can I check in and make sure? Is there any truth to what they’re saying? Maybe I should reconsider, what is it that they’re wanting? So, I also try to do my best to understand what the patient in front of me wants, what their values are and their beliefs, and try to provide care that they will actually use, that I also feel is effective and appropriate.

So, for example, I see a lot of patients that don’t want antibiotics. So, can I work around it? Sometimes maybe they aren’t as necessary, maybe I have to have a discussion with why I would recommend them, right? I see a lot of patients, so again, I’m a dermatologist in practice. I have a lot of patients who really don’t like Vaseline jelly or petroleum byproducts. I love Vaseline Jelly; I love petroleum jelly and I tell patients that I love it. I use it myself every day, I don’t believe that there’s any problem with it. And I hear you, so I don’t think it’ll work as well, but you could try this. You could try this product, right? So honest, and yet I try to meet them where they are.

I see a lot of patients who want natural medicine. So, yes, I can work with that. And this also means that sometimes I tell them that I might be the wrong physician for them. Sometimes they don’t believe in what they want to do, and can I be honest with them about that, in a way that isn’t judgey, doesn’t feel judgmental. I’m not trying to argue them out of it, I’m just sharing with them my perspective honestly, and I’m respecting their perspective. So, one example would be people who want to try to burn off their own skin cancers with these herbal caustic agents. I’m not a fan of that, I don’t believe in those. I genuinely think that patients maybe shouldn’t be doing that.

And, of course, patients get to decide what they want to do. Another example is sometimes I see children, especially young children with warts, and parents are naturally frustrated, and they want me to cut them off. My own rule is to really try to do no harm, to not cause pain to children for benign conditions that will typically self-resolve. We might talk about other treatments and other options, but again, sometimes I have to be willing to be willing to have happy patients, to not make patients happy with me, to follow my first rule, which is to do no harm or no sort of unnecessary harm, right?

So, often being a good doctor for me means not making patients happy. If I disagree with what they want, it might mean saying no, it might mean not seeing patients who are very late, it might mean dismissing patients from my practice who are either abusive or argumentative with my staff or disruptive after we’ve sort of worked through things.

So again, how do I want to show up? How am I going to assess myself? So, being a good doctor for me also means not doing harm to myself in the interest of patient care. That might look like taking lunch breaks, like not overworking, taking vacations, right? Currently, it looks like cutting back on some of my patient volume or cutting back on clinics when we don’t have adequate staffing. It means not feeling guilty for taking care of myself and my staff as well as patients, right? So, how do I show up as sort of a leader in my medical practice?

So, if you’re applying sort of the same idea of really deciding how you’re going to assess how you’re doing, to deciding if you’re a good parent or partner. It might look like showing up lovingly, regardless of the other person’s behavior. It doesn’t mean you don’t have boundaries, or with children you don’t have expectations or some house rules, but can you approach all of that? Can you approach them with love rather than anger or resentment or frustration? Maybe you decide you want to show up without yelling or without taking things personally.

Those are things you can control a hundred percent at least theoretically, right? You might not meet them a hundred percent, right? You might be at work in progress, and that’s okay too. We’re human. We’re aiming for better, not perfect. We don’t want to use this self-improvement stuff as yet another way to beat ourselves up and find ourselves not good enough. We’re lacking, that’s not the point of this. And in fact, I think that’s a misuse of this work, right? So, you might also want to assess how you’re doing as a physician or a parent or a partner, by how you judge yourself as well as how you judge others.

I have personally found that the less I judge other people harshly, the less I judge myself, right? You might notice that too. Can we give ourselves grace, just like we try to do with our patients and with people we care about. So, I really encourage you to do this work for yourself.

So just to recap, I would start by asking yourself, how do you currently know if you are a good doctor, right? Do you think you’re a good doctor? Why? Or why not? What are the metrics? How do you judge yourself? Number two, are those metrics that you can control a hundred percent, and are they working for you? Do you want to think you’re doing a good job as a doctor? Maybe you are, but maybe the way you’re grading yourself is outside your control. Number three, what are some other ways you can measure how you’re doing and decide that you’re doing a good job and get to be proud of yourself as a physician, right? That’s really sort of the steps. And again, this applies for really anything else in your life.

And again, I love the idea that we get to decide, in fact, we’re the only ones who decide, right? Other people can say, you’re doing a great job, and if you don’t believe it yourself it doesn’t matter. And other patients, other people, they might not think you’re an amazing doctor. But if you know that you’re meeting your metrics and you agree with those and believe in them and are proud of them, you aren’t going to take it personally. You can hear that as a reflection of whatever that patient has experienced, and maybe you’ve just told them no. So of course, they aren’t going to think you’re doing a great job as a doctor, but sometimes that’s what’s required, right?

Sometimes as a good physician or a good parent, even a good friend, sometimes that might require being honest and not saying something that the other person wants to hear, but can we say it with love, with affection? Can we say it from our own integrity? All of that. So, I would love to hear: what are some of the metrics that you find, are useful and helpful that you believe in. That help you know that you’re being a good doctor, that you’re being an excellent physician, that you’re showing up the way you want to?

I would love it if you would email me and let me know, and I will be opening up another round of small group physician coaching. So, if this is something that you are interested in working on or anything else, any of this resonates with you, let me know. Again, you can go to my website, www.saradill.com, S-A-R-A-D-I-L-L.com. You can sign up there, or you can just send me an email, Sara, S-A-R-A, @saradill.com and I will go back to you. I answer all my emails personally and I would love to hear from you. Thank you so much and I will talk to you next week. Bye.

If you are a busy practicing physician, ready to start feeling less stressed, enjoy work more and learn how to create a more balanced and sustainable medical practice and life, sign up for a consult call with me at www.saradill.com, that’s S-A-R-A-D-I-L-L.com. It would be my privilege and pleasure to work with you.

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