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What makes a ‘good doctor’? A critical discourse analysis of perspectives from medical students with lived experience as patients
  1. Erene Stergiopoulos1,
  2. Maria Athina (Tina) Martimianakis2
  1. 1 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  2. 2 Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Erene Stergiopoulos, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; erene.stergiopoulos{at}


What constitutes a ‘good doctor’ varies widely across groups and contexts. While patients prioritise communication and empathy, physicians emphasise medical expertise, and medical students describe a combination of the two as professional ideals. We explored the conceptions of the ‘good doctor’ held by medical learners with chronic illnesses or disabilities who self-identify as patients to understand how their learning as both patients and future physicians aligns with existing medical school curricula. We conducted 10 semistructured interviews with medical students with self-reported chronic illness or disability and who self-identified as patients. We used critical discourse analysis to code for dimensions of the ‘good doctor’. In turn, using concepts of Bakhtinian intersubjectivity and the hidden curriculum we explored how these discourses related to student experiences with formal and informal curricular content.

According to participants, dimensions of the ‘good doctor’ included empathy, communication, attention to illness impact and boundary-setting to separate self from patients. Students reported that formal teaching on empathy and illness impact were present in the formal curriculum, however ultimately devalued through day-to-day interactions with faculty and peers. Importantly, teaching on boundary-setting was absent from the formal curriculum, however participants independently developed reflective practices to cultivate these skills. Moreover, we identified two operating discourses of the ‘good doctor’: an institutionalised discourse of the ‘able doctor’ and a counterdiscourse of the ‘doctor with lived experience’ which created a space for reframing experiences with illness and disability as a source of expertise rather than a source of stigma. Perspectives on the ‘good doctor’ carry important implications for how we define professional roles, and hold profound consequences for medical school admissions, curricular teaching and licensure. Medical students with lived experiences of illness and disability offer critical insights about curricular messages of the ‘good doctor’ based on their experiences as patients, providing important considerations for curriculum and faculty development.

  • medical education
  • disability
  • Social science
  • health care education

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Data availability statement

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  • Contributors All authors contributed to the conception, design, analysis, and writing of the study in this manuscript. E.S. is the guarantor and accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish.

  • Funding This study was funded by the 2016 AMS/OMSA Medical Student Education Research Grant in Compassionate Care (Provider Wellness) and 2016 MAA CREMS Research Award in the Humanities and Social Sciences.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.