The Doctor’s Heart: A Qualitative Study Exploring Physicians’ Views on Their Professional Performance in Light of Excellence, Humanistic Practice and Accountability

Abstract Background In a field as high-stakes as health care, professional values have long been recognized as an essential mediating force for good medical practice. In the current era of changing market forces, anchoring these values in the professional performance of daily practice can be challenging. In this study we explored how physicians reflect upon their own professional performance and whether they feel they are performing to their best ability in light of excellence, humanistic practice and accountability. Methods We conducted a thematic analysis of written reflections from 786 hospital-based physicians, representing 35 specialties and 18 hospitals. Results When reflecting on their professional performance, physicians differentiated between (i) their calling for being a doctor, (ii) the translation of this calling into daily practice, and (iii) threats to their performance. Reflecting on humanistic practice triggered thoughts about the essence of being a physician in terms of calling, meaning and purpose. Physicians described concrete actions regarding pursuit of excellence and accountability. Furthermore, they suggested that their ability to perform optimally was put under pressure, mainly by heavy workloads and collaboration issues. This pressure negatively affected their calling for being a doctor and hampered the ability to be a humanistic practitioner. Conclusions In this large inventory of reflections, humanistic practice was recognized as the core value of being a physician. However, physicians feel high performance and the ability to act as a humanistic practitioner is hindered by heavy workloads and collaboration issues. Decreasing the clinical burden and reinforcing humanistic and relational aspects of care could foster an environment where physicians can perform optimally.