FFYFP Blog – Am I a Good Doctor?

By Dr. Perrin Michalyshyn

There are parts of medical training that can feel a bit cruel. Competition to enter medical school is fierce, and for many it takes years of applying before getting accepted. In medical school, there is constantly an exam or evaluation around the corner, hardly leaving any time to exhale. In residency, our lives and sleep are effectively handed over to our program for several years. It can be a grind, to say the least.

But cruellest of all is what happens when training finishes. During training, there’s constantly someone evaluating our progress, sharing tips, and giving us an idea where we stand relative to our peers. We receive years of frequent, formal, and timely feedback on our performance. Yet, after graduating…that all stops. In independent practice, suddenly it’s no longer someone else’s job to tell us whether we’re a good doctor. Instead, it falls on us. 

So, how should we go about it? It would seem there are many indicators that could offer some insight into job performance, but each of these come with significant limitations. For example, in lieu of preceptor, could we instead rely on our colleagues to tell us whether we’re performing well? To a certain extent this occurs naturally, though informally, through the insights or advice we might receive during handover or an impromptu ‘hallway consultation’. However, I’ve found that as staff physicians we often don’t have particularly deep insight into each other’s work. We are usually working alongside each other more than we are truly working together; I take care of my patients, and my colleagues take care of theirs. We’re not discussing mutual patients every day like a trainee and preceptor, nor are we necessarily prepared to jeopardize our social relationship by butting in to point out each others’ flaws. A colleague’s feedback is something, but it’s not a complete picture. 

What about patient indicators? For example, is high patient retention a sign of high-quality work? Presumably, high-quality care will keep patients coming back. But finding a new provider isn’t always simple. Outpatient family doctor shortages can make switching providers challenging, and in inpatient contexts patients don’t choose their providers at all. In these circumstances, patient retention may be less a matter of quality work and more a matter of being the only game in town. What about patient care metrics? Measures like screening rates and preventative care testing targets are valuable, but they are arguably a better indicator of patient compliance than excellence in patient care. We all know too well that the value of countless hours spent trying to convince a medication skeptical vasculopath to at least take something to bring his A1C down will never be fully recognized in a quarterly ‘Patients with A1C at target’ graph. Qualitative metrics like patient satisfaction have similar shortcomings. There is an understandable focus on ensuring that providers and the health system in general meet patient expectations, but patients can also be fickle. Take this example from an American Academy of Family Physicians article on patient satisfaction:

Consider another scenario. A perfectly healthy 70-year-old patient goes to his family doctor requesting a screening carotid Doppler ultrasound because a friend of his recently had a stroke. Dr. A spends a great deal of time explaining why this isn’t a good screening test for the patient. The patient isn’t convinced. He goes to Dr. B who immediately orders the test, much to the patient’s delight.

Who got better care? Which doctor would you prefer?

I could go on but suffice to say there is no perfect option out there. Does this mean we are doomed for a career of constant uncertainty? If we are looking for the crisp, concise, check-box style feedback of medical training, I think we will be left searching indefinitely. 

However, there are ways to adapt. Personally, rather than relying on soliciting colleagues or chasing metrics, I’ve recently tried using an approach that focuses on professional values more broadly. First, I make it my goal to be respected rather than liked. In my albeit limited experience, I’ve found that people don’t expect a doctor that always agrees with them, but they do expect, and respect, a doctor who is prepared to hear them out and put effort into finding alternative solutions when disagreements arise. Second, I aim to be honest with myself when I make mistakes. For me, this means suppressing instinctual defensiveness, resisting the urge to make excuses or simply blame ‘the system’ for unwanted outcomes, and looking for something tangible I can do to avoid making the same mistake twice. And finally, I try to accept not having a clear answer. As generalists, we have an advantage here, because we’ve been trained to live in this frustrating but unavoidable grey area clinically every day. Put more bluntly, some might say it’s about getting on with it rather than getting over it. 

So, am I a good doctor? In short, I don’t have a great answer. If anyone does, I’m all ears! In the meantime, I’ve found my alternative approach surprisingly helpful. It’s grounding and practicable, and it helps reframe things as an exercise in self-awareness instead of an external report card that needs to be aced. It’s not a perfect remedy to the cruel ambiguity of being out on our own. But, in its own way, perhaps it’s a lesson our training was designed to teach us all along.

This article was written without the use of AI