In all, ten groups of people rated the attributes. These ,groups are described as 1.

General
public, up to age 65, 2. General public, age 65 and over, 3. Practicing physicians, 4. Medical
student interns, and residents, 5. Nurses, 6. Medical technicians, 7. College students, 8. “
lower socioeconomic group”, 9. “hippies”, and 10. “blacks”. It is not clear how these
respondents were selected, but we are told that “a portion of the data for this group was
gathered in the redemption centers of a large trading company… Other data were obtained
by personal contract or by mail.” This procedure raises some doubts about the degree to
which one may safely generalize from this sample. But an even more important defect is
that the question asked do not seem to specify “patient care” or “quality”. Instead, the
authors of the report use expressions like “success” or superior performance”.

In spite of these limitations, it seemed to me that one could learn something by comparing
the rankings of the different physician attributes by different groups of respondents. Figure
2-1 is a scatter diagram of the rankings by two groups: the general public and physicians.
The spearman rank correlation coefficient is 0.83 for desirable attributes and 0.88 for the
undesirable ones. The ratings of nurses agree at least as well with those of the general
public, the corresponding coefficients being 0.91 and 0.93 respectively.

Table 2-9 gives as more detailed look at the top tem attributes as ranked by physicians and
the general public, respectively. Of these, seven attributes are shared, and the discrepancy
is small in an additional two. Both parties agree on the preeminent importance of
knowledge, judgment, thorough examination, and an appropriate recognition by the
physicians of his own limitations, as shown by a readiness to refer patients this needed. I
consider all these to be aspects of the responsible exercise of high level of clinical
competence. Beyond this area of virtual agreement, physicians, apparently more aware of
their own limitations, put greater emphasis on intellectual honesty and on the ability to
continue to learn. Members of the general public place the greatest weight on knowledge
already acquired, on the maintenance of clinical records, and on the ability to inspire
confidence in patients. A perusal of the remaining items, beyond the top ten in each
ranking. Suggests that the public places greater relative importance on attributes that
connote competence and the ability to work with patients, while physicians emphasize the
capacity to work hard and to get along with colleagues.

The degree of agreement on undesirable attributes is even greater than that on the
desirable ones. Of the five attributes ranked most undesirable by physicians, all are among
the worst five as ranked by the general public; but this degree of agreement is partly the
result of the listing of very serious defects such as alcoholism and drug addiction among the
undesirable attributes that were rated.

Figure 2-1
a summary, by its nature, must ignore a great deal of detailed information that may be
important; but in this instance it seems safe to conclude that there is broad agreement
among clients and practitioners about the meaning of good physician performance.
Although clients place somewhat greater importance on the physician’s ability to relate to
patients, and physicians on their ability to work smoothly with colleagues, both agree that
the most important thing is a high level of clinical competence exercised in responsible
manner. But more evidence should be examined before this conclusion is accepted as
generally applicable.

Some additional information on the similarity of the views of providers and clients comes
from a study of outpatient care which I mentioned earlier in this chapter ( Sussman et al.
1967 ). In this instance, a list of clinic features was submitted to the physicians, nurses,
social workers, and secretaries who worked in a clinic, with the request that they rate the
importance of each feature to patient care as they themselves saw it, and also its
importance to the patient as they perceived the patient’s opinions to be . at the same time,
patients were asked to say which of the same features they considered to be important to
patient care.

The data provided by the investigators allow for a large numbers of interesting comparisons
which are, however, extremely difficult to grasp and describe. To simplify matters a little, I
have constructed figure 2-2, taking the liberty of presenting as a continues variable
something that, obviously, is not. I refer to the several clinic features which are placed on
the abscissa in order of diminishing importance in the opinion of physicians. The left-hand
panel of figure 2-2 shows that physicians have a very highly differentiated view of the
importance of clinic features, rating some features very high and others very low. By
contrast, patients are less discriminating, in that they regard all the features as rather
important. Nonphysicians clinic staff are between, but closer to the physicians in this regard.
A second finding is that there is considerable agreement about the importance of some
features, notably “pleasant-staff”, “privacy in discussing illness”, and “same physicians in
each illness”. Physicians and patients disagree rather widely on all the remaining features,
whereas valuations of the nonphysicians clinic staff are in some respects closer, and in still
others somewhere in between.

The right-hand panel of figure 2-2 is of particular interest because it shows a comparison of
the patient’ actual opinions with the perceptions that others have those opinions. It appears
that, in a very rough way, those who provide care understand what their patients want. But
when these results are viewed in detail, there are some interesting discrepancies. For
example, the clinic staff overestimate the importance that the patients place on “seeing the
same physician on each visit” and on a “short wait for the physician”. On the other hand,
they underestimate the importance of “patient knowledge of this conditions”, “convenient
location of clinic services”, and “food facilities” at the clinic.

TABLE 2-9
DESIRABLE ATTRIBUTES OF PHYSICIANS RANKED AMONG THE TOP TEN ACCORDING TO
THEIR IMPORTANCE TO SUPERIOR PERFORMANCE, AS PERCEIVED BY PHYSICIANS AND
MEMBERS OF THE GENERAL PUBLIC. UTAH, CIRCA 1969.
A. Attributes Of Physicians Ranked Among The Top Ten as Rank by Rank by
Ranked by Both Physicians and the General Public Physicians Public
Good clinical judgment (the ability to reach appropriate 1 5
decisions regarding the care of patients)
Wise, thoughtful, able to get to the heart of problem; able to 3.65 3.5
separate important points from details
 Knowledge and ability to study patients thoroughly, and to 8.5 2
reach sound conclusions regarding diagnosis, treatment, and
related problems
Readily refers patients when it is to their advantages to do so 3.5 8.5
Keeps completely honest records 8.5 3.5
Habitually makes as thorough an examination of each patients 10 6.5
as may be required for accurate diagnosis and proper
treatment
Provides treatment appropriate to condition of each of his 7 10.5
patients with (in general) satisfactory result
B Attributes among the Top Ten as Ranked by Physicians
Able to be his own teacher: to learn from books and journals, 2.0 19.5
from meeting and his own mistakes, etc., thus adding
continually to his own education.