The ‘good’ doctor: It’s time to stop treating character like an afterthought in medicine – and everywhere else

Jillian Horton is a physician and writer in Winnipeg. She is the author of the bestselling memoir We Are All Perfectly Fine.

Last year, a familiar type of video made the rounds. Kay Burley, a news anchor on Australian network Sky News, asked MP Matt Hancock if homophobic and misogynistic statements made by Tony Abbott, the former Australian PM, rendered him unsuitable for a major role as a U.K. trade adviser.

“Obviously Mr. Abbott has got a huge amount of experience,” was Mr. Hancock’s reply. Ms. Burley pressed him: But what of his other views? They don’t matter, Mr. Hancock explained, because he’s an expert in something very important.

Mr. Hancock’s defence of his political colleague reminded me of an argument I’ve heard throughout my career in medicine, one that might as well be our of our Latin mottos: Sed ipse est bonum medicum. But he’s a good doctor.

What exactly does this mean? Usually it means, “He’s a creep, but a smart one,” or, as Mr. Hancock might have suggested of Mr. Abbott if he were an oncologist, if you would be so kind as to hold your nose and ignore his more sickening qualities, he’ll do a fine job treating your malignancy.

Doesn’t this sound like politics? Well, medicine is very political too, and every bit as patriarchal. We’re burdened with the same emphasis on hierarchies and old boys’ clubs as Parliament Hill or Queen’s Park. We have many cheeky boys – and let’s face it, they are largely boys – who are allowed to stick around because they are the equivalent of Mr. Abbott’s “good with trade.” In medicine, their so-called quirks are often celebrated. Stories about doctors who throw scalpels, scream at staff, mock colleagues or berate residents often become party fodder, rollicking narratives of our time in the trenches. And a pattern often emerges: The more inappropriate the story, the more outsized the appraisal of the surgical or cognitive skill of the protagonist. If one ever asks, why exactly was so-and-so allowed to continue to throw those scalpels, or demean those residents, or sexually harass the nurses? Well, you see, he’s a brilliant clinician who brings a lot of money into the institution – he’s good at his trade. And thus, everyone around him was conditioned to accept him as he was, because they believed a myth: that integrity, civility and character can be divorced from clinical performance and skill. Or, put another way, that clinical talent without the rest means you can still be a good doctor.

My favourite example of the absurdity of these statements is the concept of a doctor wearing pants. Would you choose to see a doctor who didn’t wear pants? What if the nurse whispered to you in the waiting room not to worry, that once you got past the lack of pants, he was an excellent doctor? Might you not still say, with some degree of alarm, perhaps this person has a serious judgment problem? Too often, in medicine, that possibility is glossed over, rationalized with the equivalent of Mr. Hancock’s answer about Mr. Abbott. His behaviour is bad. But he is good at what he does! You will just have to accept our assertion that his skill is entirely walled off from his behaviour.

Perhaps I’ve been thinking about this lately because our standard for what passes for talent in so many realms of public and professional life seems to be comprised of an assessment like Mr. Hancock’s. We’ve been hit over the head so many times with this lie that we’ve been socialized to accept and maybe even believe it. But here’s the fundamental problem with this argument, one that should surely be obvious a year into this pandemic: Character matters. It matters in politicians, it matters in doctors, it matters in lawyers and public officers of health. You cannot separate character and a person’s ability to do a job that affects people, because part of character is relating to those people. When you relate to people, you care about them. And when you care about them, you make decisions that reflect that care, and you do it in real time. Why? Because their welfare takes on a sense of personal urgency, and nothing can get in its way.

After 20 years in medicine, I have learned a simple lesson, one we are seeing play out in real time. People who lack good character don’t make good doctors or good politicians or serve much use to anyone other than themselves. They may have some technical or knowledge skills; they may even be prodigious, but their deficiencies will cost us the most precious thing of all: A civil and kind society. We cannot keep footing that bill.

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