Wednesday, December 22, 2010

Doctors – Gods, Knights, Knaves or Pawns ?

Like all professionals, doctors have a certain image about themselves . Similarly, patients have expectations of their doctors and expect them to conform to their mental model of how a doctor should behave.

Life was much easier in the past when both patients and doctors expected doctors to behave as demi-Gods. The doctor was a shaman who was considered to be a healer who had been inspired by divine powers which he could use to help the sick to get better.

In modern society, however, things have changed considerably; and few patients will treat their doctors as God-like figures ( and I feel most doctors would also be very uncomfortable in this role !)

What roles do doctors adopt today ? These are primarily three, as articulated so well by the British economist, Julian Le Grand. We perceive doctors act as:
Knights ( when their major driving force is virtue);
Knaves ( when driven by rigid self-interest ; or as
Pawns ( when they feel they are just passive victims of their circumstances.

All doctors play all three roles at various times in their life – but your primary avatar will depend upon your life experiences and your self esteem. We are Knights as we care for our patients. Always acting in the best interest of our patients is our primary professional role, and society holds us in high esteem for that. However, many healthcare activists take perverse pleasure in painting doctors as being self-interested and greedy; and paint all doctors as having Knave-like qualities ( an unflattering image some doctors help to reinforce when their primary focus seems to be on grabbing money ). Finally, in this day and age of insurance paperwork and governmental regulation , many doctors have simply given up and play the role of a bitter passive victim who is overwhelmed by demanding patients and squeezed by corporate hospitals. However, society is not kind to Pawns !

If we as doctors want society to regard us with the respect which we feel is our due, we should be aware of societal perceptions and foster a regard of doctors as Knights, and not as either roguish Knaves or helpless Pawns. Remember that society will treat us the way we expect to be treated and we will get what we deserve !

So how do you behave as a Knight and get your patients to trust you ? By proving that you deserve their trust – and you need to earn this, by being generous with your knowledge; showing your patients that you care; respecting their time; and fulfilling your promises. The hallmark of doctors who have been elevated to the status of being treated as trusted advisors by their patients is that the doctor places a higher value on maintaining and preserving the doctor-patient relationship itself , rather than on the outcome of the current consultation.

Establishing a history of reliability is one way to build trust. For example, if you tell the patient you're going to call with lab results, make certain that you do just that. Doing this the first time will show your patients that they can count on you. Doing it again and again will build trust. To win your patient’s trust, you have to behave as a professional – someone who will place the patient’s interests before his own – so that both of you benefit in the long run ! This is why senior doctors valued their reputation so much – it was built on the foundation of a lifetime of hard work – and even though it is intangible, it represents the fact that patients have trust in you.

The Trust Equation , as defined by David Maister, is simple.

T = C + R + I/ S, where

T = Trustworthiness
C= Credibility
R= Reliability
I = Intimacy
S= Self-orientation

Credibility = can your patient trust what you say ?
Reliability = can he trust your actions, confident that you will act honorably ?
Intimacy = is he comfortable discussing his feelings and emotions with you ?
Self-orientation = can he trust your motives, knowing that you care about him, and will act in his best interests ?

Professionalism is one of our core competencies , and we need to encourage all doctors to behave as Knights in the care of patients. Being a physician is still one of the greatest privileges society offers anyone, and we should always remember how fortunate we are.

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  1. Anonymous6:49 PM

    you should cite the article from which the arguments in this blog post were drawn: "Societal perceptions of physicians: knights, knaves, or pawns?" by Sachin H. Jain and Christine K. Cassel.

  2. The article is from the Jama and the abstract is at

  3. Anonymous4:48 AM

    I personally Think Dr.'s are Knights of GOD.


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