What is the role of a doctor?


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?

Part of what I do is transactional. Simple things with clear endpoints. Some of them include critical conversations and deeper types of thinking, planning, and translation.

Break down my work into different roles

I have to think about what I do every day. In my work I …

  • Find. I look for and find things. This is the discovery of problems during physical examination and endoscopy. Generally, these are things the patient didn’t know when he came to see me. These are discoveries that solve a child’s problem.
  • Fez. Transactions. These are well-defined medical findings with clear endpoints. Change a gastrostomy tube, remove a polyp, remove a button pile from a small child’s esophagus, or stretch a stenosis. There are more and more encounters of all kinds in healthcare that are being set up as transactions when they probably shouldn’t be (and why don’t we see Genius Bars in healthcare anytime).
  • Identify patterns. Much of clinical medicine is pattern identification. It’s the “see” part of medicine. I look for things I’ve seen 10,000 times. The most important thing is that I look for what doesn’t look like the others.
  • Online. Patterns come from the connection. This is the job of taking snippets of information and gathering them. Typically, this involves taking elements of a patient’s story, applying wisdom and experience, and then offering a truly educated guess as to what is going on.
  • Translate. I can find things to connect or identify related patterns, but if it doesn’t reach my parents at their level, it’s useless. I often grab something 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 tranquility. The translation of what we do is growing as patients do more for themselves and as diagnoses become more technical.
  • Show. For me, a large part of the translation is being shown. I do it visually in mine whiteboards. If I can’t show I can’t try. For me, communication and translation are the center of what I do.
  • Adjust and adjust. Parents of medically complex children know their children better than I do. They know their rhythms and patterns. This is my role as “sherpa” where I offer information to make the trip safer. New start of G-probe bolus drag in a child with cerebral palsy … “Okay, let’s do this …”
  • Answer. Retouching is effectively a response and reaction to changes in my patients. Routine labs show an unexpected increase in creatinine (a measure of kidney function) and we need to decide what it means and how to proceed. Much chronic and primary care is responding to and reacting to changes in the status quo.

That’s a lot of work. 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 father I am working with. Some people call the ability to succeed with these more ambiguous parts of patient care art of medicine. Or they use the tired characterization of way at night.

We tend to embed certain specialties with specific jobs. If you know a surgeon, you might think, “It’s a whole transaction: you just have to do surgery and go home.” She fixes things. ‘ But older surgeons get caught up in all of these tasks when dealing with problems that don’t have black and white surgical care.

Understanding our role at any time of the day is important to being effective and bridging the patient doctor divides. Patients often expect something different from what doctors offer.

How do we train when we don’t know the role of the doctor?

How do you train someone to do this? I’m not sure. It’s complicated when we can’t identify what our job is.

I taught all this myself. Part of that is a social intelligence rooted in a thoughtful layer of experience and creativity. Medical training gave me the background to start learning all of this. My best skills come from seeing other great doctors doing these things (not really knowing they are doing them). Other skills come from the comments of the tens of thousands of parents I have worked with.

Identifying the role of a physician can be the biggest challenge of our future

As technology evolves in healthcare, we must continue to ask ourselves, “what is the job of a doctor or an advanced physician?” And how is it changing? How should we evolve to stay satisfied and meet the needs of our patients? And when it comes to admissions to medical schools, how do we select the best humans for the job?

And as medicine becomes 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 operated or turned into an algorithm.

Healthcare systems need to redesign our vision of clinical work and support professionals in a way that allows them to function in a changing environment. Clinical work must be redefined in a way that capitalizes on human strengths. And it’s not about scale, process and volume. It’s about setting up the clinical space so that doctors like me can do what we know how to do best.

If you liked this post, What is the role of a doctor, you might like ours Doctoring Archives 101. It’s all written about how to do the things you do with patients. Much gained wisdom that could help.

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