TAGEDNREVIEW

TagedFiur TagedEn

TagedH1Ten Traits of Great PhysiciansTagedEn

TagedPJohn P. Higgins, MD, MBA, MPhilTagedEn
TagedPMcGovern Medical School, University of Texas Health Science Center at Houston, Houston, TexTagedEn.

TAGEDPABSTRACT

There are certain traits that differentiate great doctors from good doctors. This article will discuss some of
these traits along with tips you can incorporate to go from good to great. By applying these tips, I hope
you will enhance your ability to practice medicine and improve your patients’ experience.
Published by Elsevier Inc.  The American Journal of Medicine (2023) 136:355−359TagedEn

TAGEDPKEYWORDS: Communication; Doctor; Empathy; Qualities; Detective; Listener; Passion; Holistic medicine; Resil-
ience; Detail; Relax; Physician; Traits; TipsTagedEn

TAGEDH1INTRODUCTIONTAGEDN TagedPWhen I was a fellow in Boston, I had a 73-year-old

TagedPAlthough many good doctors are well trained in the basic patient, Henry, with confirmed heart failure. He was blind
and clinical sciences, many great doctors hold that other from diabetes, so his wife was in charge of his medicines.
habits are equally if not more crucial.1-3 For example, a After thoroughly testing and examining him, I gave him the
curious nature or detective-like approach to a patient will appropriate prescriptions. However, I continued to have all
often convert cases into real people with whom we can sorts of problems with his heart failure and lab work that
empathize.4 In addition, Edward Livingston Trudeau’s phi- would vary week to week, sometimes with heart rate
losophy, “to cure sometimes, to relieve often, to comfort control, blood pressure, electrolyte levels, creatinine, fluid
always,” is important in practicing medicine.5 I will now levels, and digoxin levels. I just couldn’t adjust his medica-
detail these habits and tips that I picked up that have helped tions to get him into the correct spot, no matter how I
me and hope that they will help transform you into a great changed my prescriptions. We checked and he was getting
[Link] the correct medications in the mail. So, it was impossible
that it was a medication problem on my end. I asked Henry
if he could bring his wife next time, so I could explore the
TagedH21) Be a Detective Like SherlockTagedEn [Link]
TagedP
TagedPThe day came, and she stated that they would receive a
“When you have eliminated the impossible, whatever month’s supply, and she assured me that Henry got the dose
remains, however improbable, must be the truth.”— for the month. While she was talking, I noticed that some-
Arthur Conan Doyle, The Case-Book of Sherlock times, she was not quite looking at me in the eye when talk-
Holmes ing. I went with my intuition and had her read what the
poster on the wall said, and she made something up, wrong
TagedEn
of course. After some probing, she admitted that her eye-
sight was deteriorating, and she could not see well but
didn’t want to alert people for fear of ending up in a nursing
TagedEnFunding: None.
TagedEnConflicts of Interest: None.
home. I then asked her to explain how she gave the medi-
TagedEnAuthorship: The author is solely responsible for the content of this cines each month—and she came [Link]
manuscript. TagedPEach month, she would receive the medicines in the
TagedEnRequests for reprints should be addressed to John P. Higgins, MD, mail; they all came in similar orange bottles, some medi-
MBA, MPhil, Professor of Medicine, Division of Cardiovascular Diseases, cines 3 or 4 bottles, others 1 or 2, but she couldn’t read
Cardiology Department, Lyndon B. Johnson General Hospital, McGovern
Medical School at the University of Texas Health Science Center at Hous-
which was which. Her solution was to open them all up and
ton, 6431 Fannin St., MSB 1.248, Houston, TX, 77030. tip them into a large cooking bowl. Then she would stir
E-mail address: [Link]@[Link] them, like mixing ingredients in a recipe, so they were well

0002-9343/Published by Elsevier Inc.

[Link]
TagedEn356 The American Journal of Medicine, Vol 136, No 4, April 2023

distributed. Then, each day, she would take an eighth-cup but you also need to focus on your patient and actively lis-
scoop and give them to Henry to take during the [Link] ten.9 I recommend you sit and face the patient while listen-
TagedPAnd our fix? My nurse obtained a braille month tablet ing and note both their verbal and nonverbal language,
container and had Henry bring each month’s supply of med- avoiding the urge to type on the computer and giving the
icines to the clinic where the nurse would put the correct patient 100% focus; they are more likely to follow your
doses in the container for the next month. After that, his advice if they feel you have listened well to them.10TagedEn
heart failure [Link] TagedPAn interesting case I had involved a man whose implant-
TagedPAlways have the mindset of a able loop recorder (that’s a subcuta-
detective, and when something neous continuous electrocardiogram
does not add up, or your gut CLINICAL SIGNIFICANCE recording device) kept showing runs
instinct tells you something else, of ventricular tachycardia during
there is likely an alternate explana- TagedEnP Great physicians have certain traits early morning hours »12 midnight
tion—so dig [Link] beyond medical [Link] to 2 am, and none during the day. I
TagedEnP These include being a detective; stay- noticed he kept breaking my gaze
TagedH22) Get Healthy and RelaxTagedEn ing healthy; listening well; finding your when I was asking him if he was
TagedP passion; treating the whole patient; having nightmares or perhaps
“Intelligence and skill can only
showing empathy; paying attention to exercising during these early morn-
function at the peak of their detail; resilience; relaxing; taking ing hours. I got the feeling there was
more to this story, so I gently probed.
capacity when the body is responsibility; and counting your [Link]
He finally confessed that he was hav-
healthy and strong.” TagedEnP Often the small gesture or little thing ing an affair, and those episodes
—John F. Kennedy. said by the great physician makes a big occurred when he was committing
TagedEn difference in the diagnosis and care of the [Link]
TagedPExercise has been associated a [Link] TagedPThis taught me that an under-
with many physical, sleep, and standing of his nonverbal cues
physiological benefits (mental and helped to correctly diagnose and
emotional benefits), including manage his problem. Patients are
relief of tension, improved self-image, and better mood, more satisfied and more likely to follow advice if the physi-
just to name a few. TagedEn 6 cian spends an adequate amount of time with the patient,
TagedPThe current recommendations are 3-5 days of aerobic has good verbal and nonverbal indirect interpersonal com-
exercise per week, 2-3 days of muscle-strengthening activi- munication, and understands the demands on the patient. 11
TagedEn
ties (resistance) per week, and 1-day flexibility or balance
training per week for a minimum of 150 min/wk.7 Being TagedH24) Find Your PassionTagedEn
healthy and strong will give you the strength and resilience TagedP
while providing your patients with a doctor who can handle “Your work is going to fill a large part of your life, and
whatever stresses they throw at you.8TagedEn the only way to be truly satisfied is to do what you
TagedPIn your life, you have probably experienced this: The believe is great work. And the only way to do great work
normal rule of effort and return only goes so far. At some is to love what you do. If you haven’t found it yet, keep
point, you can put more effort in, and the output is the looking. Don’t settle.”—Steve Jobs
same. Further on, the output starts to decrease. This is
wisely put by the Chinese idiom 物极必反(w ujı-bıfǎn), TagedEn
which means that things turn into their opposites when they TagedPWhen I was 9 years old, I was over at my best friend’s
reach the extreme, so it’s important advice for us to not house. Unbeknownst to me, they had just had their large
take things to extremes. So, remember to regroup, recharge, glass entry doors that lead out to the backyard cleaned. In
and recover, and don’t do things to the extreme. Too much my eagerness to play outside, I ran right through a glass
work leads to too much stress, which leads to damage to door, smashing it into pieces, and lacerated 2 inches of skin
your body, physically and mentally. So, remember, as a above my right knee. At the local doctor’s office, to distract
doctor, look after yourself properly, so you can look after me while suturing, Dr. Stuart Johnson let me listen to my
your patients [Link] heart with his stethoscope. This is when I heard the lub-dub
for the first time! I was completely fascinated! From that
moment, I loved all things medical. I have carried that pas-
TagedH23) Be a Master ListenerTagedEn sion with me, and I love my patients, teaching, research,
TagedP
and making a [Link]
“Listen to your patient; he is telling you the diagnosis.” TagedPMeaningful work, especially that falls at the intersection of
TagedEn —Sir William Osler one’s values, passions, and strengths appear key for health
TagedPThis means using all your senses and skill set—your care professionals to give their best.12 Additionally, those who
ears, your eyes, your heart, your mind, and your intuition— are passionate about their work are less likely to burn out.13TagedEn
TagedEnHiggins Ten Traits of Great Physicians 357

TagedH25) Treat the Whole PatientTagedEn however we can.19 All are important in optimizing the phy-
TagedP sician-patient relationship.16TagedEn
“A good physician treats the disease. The great physi- TagedPThe three types of empathy may be useful in thinking
cian treats the patient who has the disease.”—Sir Wil- about your patient in an empathic manner. Rehearsing with
liam Osler yourself by asking yourself, 1) What would you think? 2)
How would you feel? and 3) What you would like someone
TagedEn TagedPGillian Lynne was born in 1926. When she was 7 years
to do for you? may help. If, for example, you imagine that
old, she was hopeless at school - underperforming, fre-
you were just diagnosed with a life-altering condition (eg,
quently late, often fidgeting, and was not able to concentrate
cancer) that might help you before you have that difficult
for long periods of time.14TagedEn
conversation with a patient. It can be difficult putting your-
TagedPThe teachers suspected she had a learning disorder, so
self in someone’s shoes, but do your best to connect ver-
they recommended her mother take her to see a doctor,
bally and nonverbally, speak slowly, be curious, find things
which she did. While Gillian sat in the lovely oak-paneled
you have in common, listen actively, share, and always be
office, her mother explained about her fidgeting and lack of
[Link]
focus. After observing Gillian and hearing everything her
mother said, the doctor told Gillian that he needed to talk to
her mother privately for a moment outside. Just before he TagedH27) Pay Attention to DetailTagedEn
TagedP
left his office, he turned on the radio on his desk and then
walked out. A minute later, through the small glass window “It’s attention to detail that makes the difference
on the door, he encouraged Mrs. Lynne to look at Gillian, between average and stunning.”—Francis Atterbury.
TagedEn
who was dancing to the music playing on the radio. The
TagedPOne time in the emergency department, I was seeing a
doctor said, “There is nothing wrong with your daughter;
patient for chest pain. In the next stall over, the emergency
she is a dancer.” He went on to encourage Gillian’s mother
staff were treating a patient, and I overheard them ,“We
to take her to dance school, which she did. Gillian went on
have unstable atrial fibrillation; patches applied. I’m clear,
to join the Royal Ballet and performed her first major solo
you’re clear, all clear.” BAM! Then silence for a few sec-
in Sleeping Beauty at age 20.14TagedEn
onds, then “Get Cardiology STAT!” Having overheard this,
TagedPAfter a successful ballet career, she then went on to choreo-
I pulled back the curtain “Cardiology here!”TagedEn
graph two of the longest-running shows in Broadway history,
TagedPI don’t know if they were more shocked at how quickly I
Cats and Phantom of the Opera. Gillian Lynne’s gift for danc-
appeared or at the patient’s status. “Help us!” they pleaded.
ing was discovered by a doctor. A less careful physician could
I noticed an unresponsive patient with the monitor showing
have simply given her some medication or told her mother
ventricular fibrillation. I turned the energy to 200 joules on
that she would be a poor student. The great physician, as in
the biphasic defibrillator, charged it, and then defibrillated
this case, observed and treated the whole patient and, in turn,
the patient back to normal sinus [Link]
helped someone achieve amazing [Link]
TagedPLater, upon review of the rhythm strips, we noted that
TagedPHolistic medicine, which seeks to address the psycholog-
the patient had been in atrial fibrillation with rapid ven-
ical, familial, societal, ethical, and spiritual as well as bio-
tricular response around 170 beats per minute, and blood
logical dimensions of health and illness, may indeed help
pressure was 70/40 mm Hg, indeed hemodynamically
some patients to manage their illness and heal.15 It takes
unstable atrial fibrillation. Then, we noted they had incor-
genuine caring, kindness, and compassion to connect with
rectly performed defibrillation, not synchronized cardio-
your patients and heal [Link]
version, with 150 joules biphasic. We could see the
defibrillation pulse R wave delivered precisely on the top
TagedH26) Have EmpathyTagedEn of the T wave, and they had actually induced ventricular
TagedP
tachycardia!TagedEn
“People will forget what you said, people will forget TagedPSo, the key takeaways are: 1) Attention to detail; 2)
what you did, but they will never forget how you made Always have a plan B in case a problem occurs. “No plan
them feel.”—Maya Angelou survives contact with the enemy.”—Helmuth von Moltke.
TagedEn
TagedPEmpathy plays a critical role in the physician-patient You go in with a plan A, but things change rapidly, and you
need to have a backup plan or plan B; 3) Everything we do
relationship and has a positive impact on health outcomes.16
or say, or fail to do or say, has consequences; and 4) Not all
The good news is that empathy can be taught.17 The bad
patients behave or respond [Link]
news is that physicians are not good at practicing it.18TagedEn
TagedPDaniel Goldman described three types of empathy: 1)
cognitive empathy (empathic accuracy) is the ability to TagedH28) Develop ResilienceTagedEn
TagedP
understand what a person might be thinking; 2) emotional
empathy (affective empathy) is the ability to share the feel- “It’s not the strongest of a species that survive, nor the
ings of another person; 3) compassionate empathy most intelligent, but the ones most resilient and respon-
(empathic concern) is the ability to take action and help sive to change.”—Charles Darwin
TagedEn358 The American Journal of Medicine, Vol 136, No 4, April 2023
TagedEn
TagedPIt was Christmas Day and I was a newly minted intern TagedH210) Count Your StarsTagedEn
TagedP
working the dayshift in the emergency department. There
was a huge Christmas tree out front, ornaments, holiday “Lately, I’ve been, I’ve been losing sleep
music, and the nurses were wearing their Santa Claus Dreaming about the things that we could be
[Link] But baby, I’ve been, I’ve been praying hard
TagedPSuddenly, the entry doors from the ambulance bay burst Said, No more counting dollars, we’ll be counting stars.”
open: Katie, a 9-year-old girl with blood-stained clothing —Lyrics from “Counting Stars” by OneRepublic
was rushed in on a gurney. The EMS staff were doing CPR TagedEn
on her as they rushed her in. After 45 minutes, my attending TagedPI would like to think that you, as a doctor, are inspired by
physician called the code. Then came the impossibly horri- your life-saving mission in medicine. If you are spending
ble part of going to meet with the parents with my attending your life chasing coin, you will miss out on counting your
in the visitor room. I still remember the parents’ look of stars: the lives you have improved and saved already and
absolute disbelief and utter pain. The worst part was they the thousands of lives you have yet to touch. In other words,
had bought Katie a new bike for Christmas, and she had when you truly follow your passion as a physician, then
gone for her first ride on the street when she was hit by a money and fame will be a by-product of your efforts. But if
drunk [Link] you chase the money and fame in the first place, then the
TagedPThis was my first brush with the death of a child, and it true joy of being a doctor will elude [Link]
was hard for me. I remember my attending physician
putting his arm around me and saying, “this goes with the
territory.”TagedEn
TAGEDH1CONCLUSIONTAGEDN
TagedPResilience is necessary to survive the frequent exposure TagedPBeyond the medical knowledge that we have discovered
to illness and death that doctors face. You will need to take over the centuries that make a good physician, there are cer-
a step back and stay emotionally strong, knowing that tain traits that great physicians have. These include being a
you’ve done your best and need to move onto the next great detective, staying healthy, relaxing, listening well,
patient. Without resilience, the emotional burden that finding your passion, treating the whole patient, showing
comes with such illness and death is just too heavy for most empathy, paying attention to detail, resilience, taking
people to shoulder, and they burn out. I have found that an responsibility, and counting your stars. It’s often the small
optimistic attitude as well as a strong social support net- gesture or little things said by the great physician that
work help a lot. In addition, cognitive reframing, toughen- makes a big difference. Applying some of these tips
ing up, grounding connections, and work-life balance are will help you enhance your patient care and brighten your
resilience-building strategies.20TagedEn stary [Link]

TagedH1ReferencesTagedEn
TagedH29) Take Responsibility - The Buck Stops With YouTagedEn TagedP 1. Lin K. What makes a doctor truly great. Fam Pract Manag
TagedP 2018;25:[Link]
TagedP 2. Dopelt K, Bachner YG, Urkin J, Yahav Z, Davidovitch N, Barach P.
“I am not a product of my circumstances. I am a product
Perceptions of practicing physicians and members of the public on the
of my decisions.”—Stephen Covey attributes of a “good doctor”. Healthcare (Basel) 2021;10:[Link]
TagedP 3. Grundnig JS, Steiner-Hofbauer V, Drexler V, Holzinger A. You are
TagedEn exactly my type! The traits of a good doctor: a factor analysis study
TagedPAlthough there are many players in the current health on public’s perspectives. BMC Health Serv Res 2022;22:[Link]
care system, as a doctor, you will be the one that everyone TagedP 4. Fitzgerald FT. Curiosity. Ann Intern Med 1999;130:70–[Link]
else is looking up to, for a decision. If you have not already, TagedP 5. Rammya M. The pursuit of being a good doctor. BMJ 2019;366:[Link]
you will encounter critical moments where every minute TagedP 6. Markotic V, Pokrajcic V, Babic M, et al. The positive effects of run-
counts. During such situations, you will need a quick mind, ning on mental health. Psychiatr Danub 2020;32:233–[Link]
TagedP 7. Piercy KL, Troiano RP, Ballard RM, et al. The physical activity guide-
extreme calmness, and most important of all, decisiveness. lines for Americans. JAMA 2018;320:2020–[Link]
Know that making no decision is a decision itself and has TagedP 8. Romani M, Ashkar K. Burnout among physicians. Libyan J Med
its consequences. Daring to decide during those critical 2014;9:[Link]
moments may save a [Link] TagedP 9. Robertson K. Active listening: more than just paying attention. Aust
TagedPI do not doubt that you will experience a sense of accom- Fam Physician 2005;34:1053–[Link]
TagedP10. Kacperek L. Non-verbal communication: the importance of listening.
plishment and fulfilment from your daily work, but I’m Br J Nurs 1997;6:275–[Link]
afraid you will also experience frustrations and disappoint- TagedP11. Moslehpour M, Shalehah A, Rahman FF, Lin KH. The effect of physi-
ments. During those moments of disappointments, remem- cian communication on inpatient satisfaction. Healthcare (Basel)
ber “You drown not by falling into the river, but by staying 2022;10:[Link]
submerged in it.”—Paulo Coelho. And when one day, you TagedP12. Conyers L, Wright S. Designing one’s life in medicine. Postgrad Med
J 2020;96:313–[Link]
are tired of all the routines as a doctor, remember John TagedP13. Lee DH, Reasoner K, Lee D. Grit: what is it and why does it matter in
Rockefeller’s words: “The secret of success is to do the medicine? [e-pub ahead of print] Postgrad Med J. [Link]
common things uncommonly well.”TagedEn 10.1136/postgradmedj-2021-140806, Accessed November 21, [Link]
TagedEnHiggins Ten Traits of Great Physicians 359

TagedP14. Wikipedia. Gillian Lynne. Available at: [Link] analysis of randomized controlled trials. Acad Med 2020;95:
Gillian_Lynne. Accessed November 21, [Link] 947–[Link]
TagedP15. Chang AA, Siropaides CH, Chou CL. Improving communication TagedP18. Morse DS, Edwardsen EA, Gordon HS. Missed opportunities for inter-
skills: a roadmap for humanistic health care. Med Clin North Am val empathy in lung cancer communication. Arch Intern Med
2022;106:727–[Link] 2008;168:1853–[Link]
TagedP16. Decety J. Empathy in medicine: what it is, and how much we really agedP1T 9. Goleman D. What makes a leader? Harv Bus Rev 1998;76:93–[Link]
need it. Am J Med 2020;133:561–[Link] TagedP20. Hart PL, Brannan JD, De Chesnay M. Resilience in nurses: an integra-
TagedP17. Fragkos KC, Crampton PES. The Effectiveness of teaching clini- tive review. J Nurs Manag 2014;22:720–[Link]
cal empathy to medical students: a systematic review and meta-