Diligence Drives Healthcare Quality

By: Eric Bricker, MD

Healthcare is a service.  It involves tools and instruments, but at its core it is a service.  Just like an electrician or a plumber provides a service using various tools, so too do doctors, nurses, hospitals, and other healthcare providers. 

As such the quality of a healthcare service is determined not by intelligence, friendliness, or speed, but rather by… Diligence.

Diligence is defined as ‘careful and persistent work or effort.’  The primary importance of diligence for healthcare quality was described by one of the most famous doctors in history—Dr. William Osler. 

Dr. Osler was the founding physician of the Department of Medicine at Johns Hopkins Hospital over 100 years ago.  Here are some quotes from Dr. Osler about Diligence and Healthcare Quality:

  1. “By far the most dangerous foe we have to fight is apathy… Indifference from whatever cause, not for a lack of knowledge, but from carelessness, from absorption in other pursuits, from contempt bred of self-satisfaction.”
  1. “The killing vice of the young doctor is intellectual laziness.”
  1. “Maintain an incessant watchfulness, lest complacency beget indifference.  Or lest local interests should be permitted to narrow the influence of a trust which exists for the good of the whole country.”

Dr. Osler writes of ‘apathy’, ‘laziness’ and ‘complacency’ as the root causes of bad doctoring… i.e. poor healthcare quality.  Conversely, the opposite of those negative qualities is Diligence—the foundation of high healthcare quality.

Areas Where Doctors Must Apply Diligence to Deliver Quality


  1. Assessment of the Patient—Doctors must be diligent in performing a history, physical exam, and review of prior lab, imaging, and test results.  This ‘Patient Data’ is sometimes called the doctor’s ‘First Dataset.’
  1. Medical Knowledge—Doctors must be diligent in studying disease.  Medical knowledge including current guidelines for diagnosis, testing and treatment must be reviewed again and again over an entire career.  This ‘Medical Data’ is sometimes referred to as the ‘Second Dataset.’
  2. Interaction between Patient Data and Medical Data—Doctors must be diligent in comparing the First and Second Datasets.  It is in this comparison that correct diagnosis and treatment lies.

All three are necessary for high-quality patient care.  Incorrect or incomplete patient data equals poor quality.  Insufficient medical knowledge equals poor quality.  Sloopy or lazy analysis of the interaction of the two equals poor quality.

How to Assess Diligence

Here are three ways a patient can assess diligence themselves:

  1. How Well the Doctor Listens—Diligent assessment of the patient takes TIME and ATTENTION.  If the doctor does not take the time and pay attention to listen to the patient, then the first data set will be wrong.
  1. How Well the Doctor Explains Things—A medical truism is ‘If you can’t explain it, you don’t understand it.’  Doctors with sophisticated medical understanding can articulate that understanding using simple, declarative sentences.  The more elegantly simple the explanation, the better the understanding.  Conversely, doctors with an unclear understanding tend to have unclear explanations.
  1. If the Doctor Washes His/Her Hands in Front of the Patient—While this is not a foolproof method… if a doctor is attentive enough to physically demonstrate to patients that they are safe and literally in ‘good hands’ with them, then it is more likely that the doctor is attentive in thinking about the two datasets involved in patient care.

How to assess doctor quality BEFORE ever meeting the doctor will be a topic of a separate blog post, but the above frameworks can get you started down the road of high-quality care.

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