In a time when defensive practice conflicts with prudence and established practitioners bemoan the current state of the profession in light of a more glorious past, there are few consistent models representing the ideal physician for those training in the medical art. This is not to say that there are no heroes: there are numerous role models among practicing physicians and teachers. However, the medical field as a whole does not not cultivate an ironclad internal philosophy in the same way that one might find in a military academy or a successful company. Senior physicians might argue that the highly intellectual nature of medicine precludes a simplification of the core values underlying medical practice. However, all effective organizations have an infrastructure of core values that its members must aspire to and uphold at any cost. The medical profession’s core values suffer from adulteration by third parties that try to dictate how physicians should practice medicine and what doctors should be. If we cannot decide for ourselves the principles that we must follow, then others will, for better or worse.
We must know the essential qualities of an ideal physician. But where can we find them? Certainly not in popular culture. Physicians of the past had Marcus Welby; we have Gregory House and the fickle white coats of “Grey’s Anatomy.” But we also cannot rely on other external influences including our teachers (physicians who trained in a different era) and our patients. We must see beyond the nostalgia of our predecessors and the approval of our patients and their families to determine the true core values underlying the makings of the ideal modern physician.
The first measure of a great physician is excellence in clinical judgment: the accuracy of diagnostic methods, the thoroughness of approach, and the effectiveness of proven clinical decision-making principles. This obviously arises with the necessary prerequisites of intelligence, intellecutal curiosity, and well-developed logic and critical thinking skills. What follows, and is just as essential, is the ability to carry through the plans of action dictated by the clinical reasoning process, whether through coordination of care, the administration of pharmacotherapy, or the application of steel to the diseased body. Merely having good clinical reasoning and technical skills is not enough, however. The tireless compulsion to perform at maximum capacity is the true meaning of excellence.
However, always striving to deliver the best care possible should not be equated with ordering every test and calling every consultant. Rather, there is a careful balance between acting prudently and aggressively taking action.
A great physician enters this profession with a love for humanity. A great physician, despite the hardships of training and temptation of cynicism, never loses this love for his or her patients. Compassion is a core value of humanity as a species, and it is the primary fuel for the physician’s mission. For the modern physician, compassion represents the underlying emotional connection formed with each patient despite the bureaucracy, paperwork, and lack of time, and this connection is the fundamental basis for healing.
The modern physician never works alone. Health care delivery, with the practice of medicine at its center, is reliant on teamwork. Loyalty means a great deal to the physician. It represents his friendship, support, and guidance of other care providers such as nurses and technicians. It represents the development of camaraderie within a specialty field among fellow residents and among physicians as a category. It represents respect for his mentors and teachers and the carrying of their messages and teachings to future generations. And it also represents the commitment to help fellow physicians see their mistakes and correct them in a supportive manner. (This last one, in particular, is incredibly important because past generations of physicians did a poor job of internal policing and correction, thus allowing the encroachment of outside parties who inevitably tend toward seeking punishment for mistakes instead of re-education or reform.)
While our forebears wax poetic about the hardships of their storied early careers, it is important to understand that these comparisons are as based in reality as the practice of phrenology. The practice of medicine is constantly evolving and introduces many new challenges while attenuating others. Whereas physicians in the past may have worked longer shifts for more continuous stretches of days, they also did not have the same burden of paperwork, the complexities of care coordination, or even the complexities of addressing the wishes and perceived needs of patients (i.e. paternalistic care is much easier to deliver, but it is not better). Nonetheless, the underlying message is valuable: the willingness to persevere against hardship is a core value for physicians, because our jobs are not easy. We cannot give up once we have picked up the mantle for our patients. This is not to say that resident physicians should not complain about abuses and injustices or strive to make improvements in their lives, but often it is necessary to hunker down and push through the barriers, shoulder to the wall.
Last but not least, the practice of honesty is a core value of the modern physician. There are numerous occasions within the lives of a young physician when she is called upon to lie, bend, or obscure the truth: when a colleague makes a mistake but she must document her findings accurately and diplomatically, when a more senior colleague or attending physician comes to a conclusion that she does not agree with, or when it is requested by a family member or senior colleague that a suspected diagnosis not be revealed to an inquisitive patient. Nonetheless, there is no way to gain the trust of one’s colleagues and one’s patients if honesty is ever compromised. A forgotten exam maneuver should never be filled in with a fabricated finding. A question regarding the possibility of cancer as a possible explanation should never be sidestepped. The foundation of integrity is trust, and trust cannot be earned without consistent demonstration of honesty. A modern physician must be all of these things.
Do you have other ideas for core virtues modern physicians should have? If so, please write back in the comments section!