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The Good Doctor: Lessons from Positive Deviants

The Good Doctor Lessons from Positive Deviants

Press Ganey’s Chief Medical Officer, Dr. Thomas H. Lee has become one of health care’s most acclaimed thought leaders. In this article he explains the lessons he learned from other physicians and how they found passion through their work.

In every field, pressures for performance are intensifying, but burnout among personnel threaten organizations’ ability to adapt and improve.  These pressures are especially intense in health care, where medical progress has led to wonderful advances, but also rising costs and chaotic experiences for patients and the people taking care of them. Symptoms of burnout are unusually high among physicians and nurses, and associated with suboptimal safety and quality.

Nevertheless, there are many clinicians and other personnel in medicine whose love for their work drives them to go beyond any job description. Their motivations are not different from others in health care, but somehow they are persevering in their efforts to meet their patients’ needs – even when their perseverance takes them to some pretty unconventional places, like starting a summer camp for children with the condition upon which a surgeon specializes.

 The Good Doctor is an exploration of what can be learned from seven “positive deviants” – physicians who have found sustained passion through their clinical work.  They have not cut back; instead, they do more. They range in age from their very late 30s through their early 50s – in short, they are not so young that they don’t know what they have gotten into, and not so old that they can view their career with nostalgia. They all have a long way to go, and they are doing wonderful work as they do.

The book had its origin in a discussion about Merit Cudkowicz, the chief of neurology at Massachusetts General Hospital and a leading expert on amyotrophic lateral sclerosis (ALS), an incurable neurological disease known also as Lou Gehrig’s Disease. More than two decades into this work, Merit leads a team that delivers wonderful care while attending to the psychological needs of the entire family. Colleagues frequently say of Merit, “She should be the most burned out physician on the planet, but somehow she is the least.”

Talking about Merit led to discussions about Emily Sedgwick, a breast radiologist who redesigned her breast cancer screening program to reduce unnecessary fear for patients, and Laura Monson, a surgeon specializing in repair of cleft palates who started that summer camp because she realized that her patients and families were more worried about social issues than the details of the operations that she was performing.

The stories of these physicians were all wonderful, but what can be learned from them collectively? I used a technique developed by anthropologist Jiro Kawakita to analyze their stories, and the lessons that emerge suggest this “chain of events” for the development of these Good Doctors. 

  • They all start by having tremendous empathy for their patients
  • That empathy leads to a deep sense of purpose for their work
  • They want so much to help their patients that they are resilient in overcoming barriers that stand in the way
  • They are excellent collaborators with those who are ready to join them

My sense is that this sequence or its equivalents are generalizable to other types of personnel and other fields beyond doctors in medicine. In any case, I’m quite sure that they are relevant to many more physicians than the ones featured in this book.  I’ve done podcast interviews with these seven, and now more and more are being identified, and I’m adding their interviews to the site ( It doesn’t look like we are going to run out any time soon.  And there are still plenty of lessons that they have to teach us.

To read more from Dr. Thomas H. Lee check out his new book The Good Doctor.

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The Good Doctor: Lessons from Positive Deviants

Dr. Thomas Lee joined Press Ganey as Chief Medical Officer in 2013, bringing more than three decades of experience in health care performance improvement as a practicing physician, a leader in provider organizations, researcher and health policy expert. Tom, an internist and cardiologist, continues to practice primary care at Brigham and Women’s Hospital in Boston