"Good Doctors Leave Good Tracks."

This saying was the mantra of the most influential teacher I ever had - the doctor who taught me how to persevere through the daily sturm und drang of caring for those living with cancer. His theory was that you can always tell when a good doctor has been involved in a patient's case by the type of "trail" he or she left behind after the work was done - a ship's wake, if you will, that represents the effect the doctor had on the patient's life, a trail that does not always guarantee a healthier patient but that shows the world the type of doctor who captained the mission. This imprint reveals the depth and worth of the doctor's effort. The converse of the apothegm therefore is just as true: "Lousy doctors leave behind lousy work."

With a little training anyone can become an expert in deciphering the tracks of a doctor. It seems to me more apropos to illustrate the marks of a praiseworthy one, rather than try to describe the flotsam left behind by a hack - after all, I wouldn't want to be accused of being cynical!

Well then, let's take a look at the trail a perfectly wonderful physician leaves behind at the end of the day. These are the clues you have hired a good one:

The Written Word. There is no easier way to separate good and bad doctors than by the dictated reports, handwritten orders and notes, and letters they produce - by the ream, I might add. Good doctors have legible handwriting, no matter how much of a hurry they are in. They take the time to document the important facts of a patient's illness and the information relayed to the patient. Counseling sessions are put into the written record - the risks, possible side effects and alternatives of a treatment are recorded. The medical record should be inscribed so that a new doctor could pick it up the next day and know immediately what the case is all about.

The Spoken Word. I have already commented on the importance of proper communication with patients in an earlier post, but let me add this: a good doctor speaks clearly and respectfully, avoids medical jargon and slang, shuns a prejudicial attitude, never assumes that one attempt at explanation will be sufficient, nurtures assurance and hope in a time of dread, and tries to share the joys of jocularity when appropriate. It's as easy as that!

Critical Thinking and Investigation. Good doctors never assume that the patient's symptoms are due to the same old run-of-the-mill maladies that they see day after day. They excel at what is called lateral thinking - thinking "outside the box" of routine illnesses. They question themselves - "Do I have the right diagnosis?" They order tests that seem to fit the patient's clinical presentation, not just to get a nice peek at every organ in the body. When they are stumped, they research the question - and keep searching the medical literature until they are satisfied that they have a handle on what the problem is. If not, they ask an expert. A good doctor gets smarter every year by his commitment to lifelong learning.

Following-Up. Lastly, it is tedious but vital that doctors review the results of all the tests they order, that they keep in contact with sick patients who might suddenly get worse, that they double-check their plan of attack for an illness (especially cancer), and stay knowledgeable with current medical news and new developments. As the great physician Sir William Osler said, "To study the phenomenon of disease without books is to sail an uncharted sea..."

Osler was a bedside healer by the way, not just a laboratory researcher and the second part of this quote is "...while to study books without patients is not to go to sea at all."

Every morning a doctor sets sail into the vast and deep blue of medicine, eyes on the horizon and on the sky, with the hope that the voyage will be untroubled and lead to a life saved, a burden eased, a soul comforted. By watching the foamy trail left behind, we who are in need of the doctor's mastery can determine whether he or she is the right skipper for the journey.