Ethical Dilemmas for Healthcare Professionals: Can We Avoid Influenza? (Stokowski, RN, MS)

Generations ago there was a young man name Aloysius Gonzaga. He cared for plague patients. Later, he contracted the disease himself and died. Saint Aloysius is a man I have long admired. It has always been such a profound situation for me to consider. Not only caring for the patient but the sacrifice in uniting with their condition to such a, well, fatal degree.

Health care professionals are trained to care for the sick. If they aren't ready to go to battle in times of great medical need, who can? I certainly don't think that every physician should encounter the same fate as St. Aloysius. But I do think that times of intense challenge, such as a pandemic, shouldn't paralyze the medical profession. It is a time to respond. As the article mentioned, preplanning of emergency protocol and supply/use of personal protective equipment should be an essential element of any health care institution to prepare to address the challenge in the best manner possible.

Is there a duty to care? To those whom much has been given, much is expected. Right? To what degree? I don't know until I get there.

Greed: The Sin of Wages (Atul Gawande, MD)

Can I ever work for the poor and pay off my medical bills? In my typical optimistic manner, I trust that I can, although the practical components of my future financial plan are, well, as of yet unidentified. I am fascinated by a medical practice that can accept no insurance and flourish, providing what I am sure is state-of-the-art, elite care. My question is, how can I provide such care for the poorest of the poor? Surprisingly, I guess I am not appalled by those who view our profession as purely business. I just want to harness that economical prowess (a gift that I do not have) and put it to work for a good cause.

Is it unprofessional to provide good care and be highly reimbursed for it? I don't think so. Is it professionally unfair for some to have the capability to pay highly for superb care and for others to not have the resources even for minimal care? Yes. Perhaps even objectively yes. Can the health care establishment exist successfully with such dichotomies? I don't know. Our government is trying to figure out this very thing right now. As medical professionals, so must we.

The Right Road for Medicine (John Ring, MD)

I do not know much about the AMA, but if this short publication of Ring's truly illustrates AMA sentiment, I must say, I am pleasantly surprised.

For me, medicine is definitely a service profession. I was impressed by Ring's appall at the modern move from this mindset to that of medicine as purely business. I recall in nursing school when we were encouraged to call our patients "clients" instead. The intention was to empower the individual to engage in their health and the health care process. The patient as a consumer of health care. But I never employed this verbiage. The nurse-patient (and now doctor-patient) relationship is sacred to me, and to me, the word patient does not indicate a reliance on me but rather it reminds me of my professional responsibility and personal joy to be a compassionate aide in their healing process.

I hope that Ring's perspective represents that of his fellow AMA physicians and of the profession as a whole.

Are Overweight Doctors a Problem for the Profession? (Centor, et al)

Every person should adopt a healthy lifestyle. Should we forever avoid the deliciousness of ice cream on a hot summer day? No. But nine times out of ten we should pick a healthy food instead. If we miss a day of exercise, should we be outcast from society? No. But we should find ways to stay active each day, even if it is just walking or biking instead of driving. Even if we may choose not to be a marathon athlete or a strict vegan, there are minor (and dramatic) lifestyle changes that can and should be made.

As a health care professional, I think it is important to model the lifestyle I hope my patients to aspire to. Certainly, a day in the life of a doctor is certainly full. But so is the day in the life of a stay-at-home mom or a construction worker or a teacher or student. I do believe that overweight doctors can still provide excellent care. I also believe that the vast majority of persons benefit intellectually as well as physically from regular exercise. Sound nutrition and physical active can only benefit.

In conclusion, I think it is the small things that are most important that a physician model. Taking a walk in the mornings. Limiting portion size. The small changes that can prove great benefit and cost little. We not only become healthier in the process, we also bring credibility to the feasibility of a simply healthy lifestyle.

The Most Powerful Therapeutic Force (Joseph B. Kirsner, MD, PhD)

“It is not enough for the physician to mean well: the physician must know enough to do well. In no way should the advance of scientific medicine blunt the humanitarian approach to the patient.”

A compassionate presence is transformative and healing. As a nursing student, I often considered the unique role I played. I was not essential staff. I was responsible for my patient(s) but not ultimately so. I had more time than the staff nurses. With this time, I loved to sit by the patient bedside, chatting and simply being a supportive presence. I tried to remind myself to soak in these moments, learn from them, reflect on them, because as a working professional the time allotted for such interactions would be more limited. Hearing stories about third- and fourth-year medical students seems like it may be a similar experience.

But the question really is how can I maintain that humanistic touch even as a practicing physician? I truly love and really live for the relational dimension of this profession. Will I have that gift of time to develop the patient-doctor relationship? I think I must choose to live compassion with whatever amount of time I am given with the patient and find a practice (or develop one ☺) that allows me to be the physician I desire to be.

What Does it Mean to be a Physician? (Michael E. Whitcomb, MD)

In this article, Dr. Whitcomb presents an intriquing thesis: it is not so much the knowledge and skill set that essentially define a physician but rather certain personal characteristics. For Whitcomb, these attributes – being caring, inquisitive, and civic-minded – are what truly embody the essence of a physician, or rather, a good physician.

A few points were of key interest to me.

1. Whitcomb referred to these desirable qualities as those which are the “public’s expectations” of what a good doctor is. Although colleague respect is important, we must remember the reason we do what we do: our patients.

2. “The secret of the care of the patient is in caring for the patient.” (Francis Peabody) As a nurse, I have experienced that more than the treatment I have provided, what has been most healing for the patient was the compassion and respect with which I delivered the care.

3. I was impressed that his “inquisitive” trait referred not only to continuing education but also to patience in the diagnosis process.

4. The final element of special interest to me was that Dr. Whitcomb stated that these attributes should be part of medical school training. I suppose it always has been in a certain way but his suggestion that there is a concerted effort to make it a learning objective is important.