What do we need and look for in our doctor?
Screening and entrance test for various professional colleges and careers have components of aptitude testing. Now aptitude test is being introduced for the civil services of India as well. The profession where an appropriate aptitude and attitude is essential is the field of medicine. The spectrum of healthcare professionals right from doctors to nurses and a variety of technicians need to be temperamentally gentle and caring but nowhere prior to admitting them in to profession these inherent tendencies are evaluated.
What do we need and look for in our healthcare professional?
Probably the answer to this question uniformly would be – care and compassion along with professional skills. This would be followed by list of few more varied qualities depending on individual needs. Professional skills are taught and continuously upgraded in the medical colleges and other higher centers of learning but who can teach one to be humane and compassionate?
As of today, all Pre Medical and other Selection Tests conducted in India mean an examination in the subjects of Physics, Chemistry, Zoology and Botany. Whosoever scores the maximum is chosen to be a healthcare professional. The selected candidates are usually in the age group of 18 to 22 years and from a variety of backgrounds or upbringing i.e. young adults with certain formed ideas. Incidentally there is nothing in this test, which checks the psyche or psychology of a person. Nowhere is it assessed that whether the candidate is capable of being and remaining compassionate and humane in various circumstances and situations. Greatness in sciences such as biology, chemistry and physics does not mean achieving greatness in practice of medicine. Shouldn’t some psychological tests form a part of the assessment of short listed candidates in PMT? The medical curriculum being followed in India’s medical colleges till now also lacks any discussion on patient psychology, humanitarian issues and communication skills in the teaching program, although the new medical council is giving a thought to it.
We Indians are rather poor in identifying or analyzing our problems through the means of research but a large body of research is available in western academic medical literature on this issue. Western research shows that performance in the premedical sciences is inversely associated with many of the personal, non-cognitive qualities so central to the art of medicine.
Harrison Gough, a psychologist at the University of California, Berkeley, administered a series of psychological tests to 1071 students entering medical school between 1955 and 1967. Gough reported that student’s premedical science grades and entrance test science scores were associated with grades in the initial medical subject (normal human anatomy, physiology and biochemistry – called basic sciences of medicine) but had no association with the later phase and subjects (clinical sciences) of medical curriculum. The clinical sciences require more general and clinical competence. He then compared the psychological profiles of these students with their performances in premedical sciences.
He found that the students who did better in science were, “narrower in interests, less adaptable, less articulate, and less comfortable in interpersonal relationships” in other words reverse of what one might hope for in a physician. Various other researchers have also worked on this hypothesis. Writing in the 1970s, Witkin found students who were most successful in the sciences, “have an impersonal orientation; they are not very interested in others”. Tutton’s studies of medical students in Australia in the 1990s found that students who did the best in the premedical sciences scored lower on standardised measures of empathy and tended to be “shy”, “submissive”, “withdrawn”, or “awkward and ill at ease socially”, characteristics the author suggested are, “the antithesis of what most of us would want in a clinician (doctor)”.
Dr Donald Barr of Stanford University USA has expressed it the best when he wrote in the prestigious medical journal “The Lancet” recently. “Great physicians base their professional practice on a threshold of scientific knowledge they have acquired throughout their career. Upon this foundation they build an artistic display of communication, compassion, empathy, and judgment. A great physician creates a bond of communication and trust with his or her patient; a great physician can sense the feelings the patient is struggling to express or afraid to say; a great physician is also technically competent and conversant in medical science.”
In selecting students for the study of spectrum of health care related professions, we must be careful to formulate some method, which takes in to account both the scientific acumen and a psyche of the candidate and we must do it quickly.