Abstract
Doctors are described as those individuals who diagnose and treat human physical and mental illnesses, disorders and injuries and recommend preventive action based on the scientific principles of modern medicine. They may specialise in certain disease categories or methods of treatment or assume responsibilities for the provision of continuing and comprehensive medical care to individuals, families and communities. 6
Doctors are expected to show competency, have patient welfare at the core and patient interest above their own. The Royal College of Physicians of London, in a report (2005), proposed that morality was fundamental to the practice of medicine and social contract should be named moral contract.
A doctor must be a healer who is competent, altruistic, moral, trustworthy, ethical, accountable, be competent and transparent. Other factors such as private sector, media and regulators are important too in creating the right environment for the practice and delivery of medicine.
In the 19th century, Trudeau 1 described the role of the doctor as to cure sometimes, to relieve often and to comfort always. Matthew 8 argues that this may be an idealistic position and also suggests that empathy is an abstract concept. The underlying message is being a good listener, listening to the patients and being comforting. Listening, detective work, empathy, treating the patient and not their disease are key characteristics of a good doctor. Schnelle and Jones, 11 in a public survey showed listening as an important skill for diagnosticians as well as interventionists. Higgins 5 describes 10 traits of great physicians, of which listening is the key.
The CanMEDS Framework 9 proposes that doctors need competencies in order to be medical expert, communicator, collaborator (team player), leader, health advocate, scholar and professional. Some of these competencies will be described and discussed in detail in subsequent papers. The CanMEDS Framework 9 offers a coherent and ethically grounded basis for training in and assessment of key relevant competencies. Not surprisingly, the framework is being increasingly used not only for assessments but also accreditation as a symbol of achieving these competencies. Of course, there are challenges in assessing competencies which include proper assessments preferably by supervisors and also by external assessors. Since its original development, the framework has undergone various iterations to reflect healthcare changes and evolving patient needs.
The CanMEDS Framework highlights various competencies that a doctor must have, which allows trainers and trainees to agree set goals in order to assess progression. It includes seven distinct competency domains (the CanMEDS roles) that include skills, responsibilities and activities that physicians should display to support their patients. Namely, these are medical expert (the integrating role), communicator, collaborator, leader, health advocate, scholar and professional, described very briefly below. Of course, there will need to be additions as societies change and evolve but the core characteristics remain the same. Tweedie et al. (2018) make similar observations. The key components are described below. More detailed descriptions will be provided in subsequent papers.
Medical expert
Reaching a diagnosis, investigating accordingly and setting up appropriate therapeutic interventions are at the core of being a medical expert. These medical expert competencies are based on existing best practice and latest evidence, accounting for patient needs and preferences, but by keeping up-to-date these indications change. In order to deliver high-quality evidence-based care, physicians need to be able to work in a team, aware of recent developments, be a good communicator – all of which are part of the framework. Medical experts must demonstrate a commitment to lifelong learning and robust ethical and professional standards.
Communicator
As mentioned above, a physician must be a good listener but equally importantly they must be a good communicator not only with the patient, their carers and families but with the public and policymakers too. Clear communication is essential to improve therapeutic engagement through shared decision-making. Medical expert must communicate effectively with other healthcare professionals too in order to facilitate service delivery.
Collaborator
In this context, collaborator means team player. In order to be a team player, physicians must be aware of the respective roles of various team members as well as their skills and be cognisant of team dynamics. It also involves working with patients, their carers and families and also to be an advocate thereby linking with other competencies.
Leader
In this context, the role of the leader is not only to lead on collaborative decision-making but also taking responsibility for patient care often directing clinical, scientific, administrative, or educational activities. As a leader, the physician needs to drive positive change through quality improvement. They require leadership skills working with other partners in patient care.
Health advocate
A physician has responsibilities to advocate for their patients, both at personal and local, regional and national levels. They need to share and communicate widely and wisely about geopolitical and social determinants of health proactively. Physicians are well placed to be advocates by dint of being clinicians and experienced as well as respected members of the society.
Scholar
Physicians must be aware about recent developments in research affecting their clinical domain in order to offer evidence-based interventions. They may or may not engage in research but should be able to interpret data and findings that can help improve the quality of services too. They must be able to critically appraise research that will help them in teaching, lifelong learning and continuous professional development.
Professional
Being a professional means being aware of imperatives of any specific profession. In this case, it is essential to recognise their ethical, moral and legal obligations, including confidentiality and privacy. This has become increasingly relevant after the pandemic, with increasing use of tele-health assessments and management and practising with integrity and probity. Physicians must demonstrate both compliance with regulators and accountability.
Grundnig et al. 4 used a questionnaire to explore public perceptions of their doctors. They found that there were six types of doctors: dutiful, online health celebrity, medical expert, service physician, medical altruist and the ethical agent. Khawar et al., 7 after a systematic review, reported that characteristics of good doctor were classified into competencies (communication, professionalism, knowledge), motivation (leaving and patient care) and personality empathy and flexibility. Rizo et al. 10 offer respect, support, promote, information, courtesy unbiased, evidence based, cooperation and advocacy as essential characteristics in the context of right work–life balance. Physicians should be aware of their mental health and wellbeing needs and maintain their own wellbeing through self-care initiatives. This will be described at length in a later paper.