That sounds like a crazy question. But it really isn’t. What does a doctor do? What is my job with my patients. What is the role of a doctor?
Some of what I do is transactional. Simple things with clear endpoints. Some of this involves critical conversation and deeper ways of thinking, planning, and translating.
Divide my job into different roles
I have to think about what I do every day. In my work I have …
- Find. I search and find things. This is the discovery of problems during physical examination and endoscopy. Usually these were things the patient didn’t know about when he came to see me. It is discoveries that solve a child’s problem.
- Do. Transactions. These are well-defined medical encounters with clear endpoints. Changing a gastrostomy tube, removing a polyp, pulling a button battery out of an infant’s esophagus, or stretching a stricture. Increasingly, healthcare encounters of all kinds are turning into transactions that probably shouldn’t be (and why we won’t see Genius Bars in healthcare anytime soon).
- Recognize patterns. Much of clinical medicine consists in the identification of patterns. It is the “seeing” part of medicine. I’m looking for things I’ve seen ten thousand times. More importantly, I’m looking for the thing that doesn’t look like the others.
- associate. The patterns come from the connection. This is the job of gathering information and putting it together. This usually involves taking elements of a patient’s history, applying wisdom and experience, and then making a really educated guess as to what is happening.
- Translate. I can find connections or in terms of patterns, but if it doesn’t appeal to my parents at their level, it’s worthless. Often times I take something that I find (or they find) and translate what it means or why it may be meaningless. Why it’s relevant, irrelevant, or just plain funny. This is the piece of reassurance. The translation portion of our work is growing, as patients do more of their own work and diagnostics are becoming more and more technical.
- Demonstrate. For me, a large part of the translation shows up. I do this visually on my whiteboards. If I can’t show, I can’t handle. Communication and translation are the focus of my work.
- Optimize and customize. Parents of medically complex children know their children better than I do. They know their rhythms and patterns. This is my “Sherpa” role, in which I provide insights to make travel safer. New onset of gagging with g-tube boluses in a child with cerebral palsy … “Okay, let’s do that …”
- Answers. Optimizing is effectively reacting and responding to changes in my patients. Routine labs show unexpected spikes in creatinine (a measure of kidney function) and we need to decide what it means and how to go about it. Much of the chronic and primary care is responsive and responsive to changes in the status quo.
That’s a lot of jobs. So it’s easy to see why I’m confused.
Most of these things are done in combination – everything is experimental and continuous, depending on the parents I’m working with. Some people call the ability to succeed with these ambiguous parts of patient care the art of medicine. Or they use the tired characterization of the bedside manner.
We tend to associate certain specialties with certain occupations. When you know a surgeon, you might think, “It’s a transaction – just do an operation and go home. She fixes things. ‘ But the greatest surgeons do all of these jobs when treating problems for which there is no black and white surgical cure.
It is important to understand our role at any point in the day in order to be effective and to bridge the doctor-patient gap. Patients often expect something different from what doctors deliver.
How do we train if we don’t know the role of a doctor?
How do you train someone to do this? I’m not sure. It’s complicated when we can’t see our job.
I taught myself all of this. Some of this is deeply ingrained social intelligence with a layer of thought of experience and creativity. Medical education gave me the background to learn all of this. I got my best skills by watching other great clinicians do these things (without really knowing they are doing them). Other skills come from feedback from tens of thousands of parents I’ve worked with.
Identifying the role of a doctor can be the greatest challenge of our future
As healthcare technology advances, we must continue to ask, “What is the role of a doctor or an advanced practitioner?” And how is it changing? How do we need to evolve in order to remain satisfied and meet the needs of our patients? And when it comes to medical school admission, how do we choose the best people for the job?
And as medicine becomes more industrialized, we need to remember that some of the most important things we do cannot be reduced to a process. Take another look at this list – there isn’t much that can be operationalized or turned into an algorithm.
Health systems need to restructure our view of clinical work and support professionals so that they can function in a changing environment. Clinical work must be redefined in such a way that human strengths are used. And this is not about scale, process and volume. It’s about designing the clinical space so that clinicians like me can do what we do best.
If you enjoyed this post, What Is the Role of a Doctor, you may like our Doctors 101 Archives. It’s all written about how you do the things you do to patients. Hard earned wisdom that could help.
