Many recent articles, blogs, and presentations have focused on what American health care lacks and what additional skills health care professionals should adopt to “fix” our “broken” system. Third-party payers and health care organizations tend to promote the need for quality improvement and economic measures, while clinicians grapple with their transition to less-autonomous employees, noting increased job dissatisfaction and conflicts regarding administration and reimbursements. The theme that American health care is broken even permeates medical education, with students noting the detrimental effects of daunting student loans and the empathy-crushing “hidden curriculum.” This is all to say what we all know; medicine is challenging, but this is not the first time it has been or last time it will be.
Thoughtful authors have long looked outside health care for solutions, but I believe medicine can also be improved by remembering to share something we each possess: the human capacity to love. Although we each possess this ability, I am surprised how often I feel it missing from interactions with patients and colleagues. Patients can see 30+ doctors, nurses, residents, and students in a morning of rounds without a single person sitting with the patient as an equal to synthesize and reflect upon his or her health status and goals; services bicker and compete, where egos flare, and patients are all but forgotten; and students are subtly and not-so-subtly reminded that their notes, past experiences, and even names do not matter.
It’s ironic really that one can find more empathy and compassion in some convenience stores than some health care facilities. As such, I think it’s instructive to remember the work of John Gregory who inspired the American Medical Association’s first Code of Medical Ethics through his student Thomas Percival. Gregory was a Scottish physician and scholar who was disturbed by the greed and lack of compassion he observed in 18th century London physicians. He felt medicine was being treated as a trade rather than a profession, and sought to describe the proper character of a physician. Inspired by David Hume’s work on the human capacity for sympathy and the character he saw in his grandmothers, he concluded that ideal physicians convey and balance tenderness and steadiness.
These concepts were part of the original 1847 Code of Medical Ethics but were slowly replaced with principlism, which dominates medical ethics education today. Although autonomy, beneficence, and justice are important, there is a palpable distance between these principles and day-to-day thoughts and activities. In other words, it is rare to hear health care professionals use these terms unless specifically discussing “an ethical issue/case.” Other concepts such as “patient-centered care” or “health care quality” are less abstract but are often used ubiquitously without further definition. To me this depersonalizes ethics and shifts our focus away from reflecting on our personal-professional values and whether or not our daily actions convey these convictions. As put by Jonathan Imber regarding medical virtue ethics, “the problem in medicine as in all professional life is not whether the emperor has no clothes, but whether the clothes have no emperor.”
The original meaning of “virtues” in ancient Greek philosophy was “tools” or “excellences” which allow an individual to achieve a particular telos or primary ends, which in medicine, I would argue, is healing persons. In order to heal others, scholars throughout history have emphasized similar virtues. Health care professionals must be self-aware, trustworthy, modest in their pursuit of personal gains, compassionate yet firm, and intellectually curious. Similarly, I would describe those I admire in health care (and throughout life) as honest, sincere, dependable, thoughtful, and successful yet humble.
So what about love? In reflecting on these virtues, love seems to be the cornerstone: love of others/service, love of knowledge/learning, love of one’s community/family. Love pushes us to empathize with and care for others despite the inconvenience and personal cost, yet remain firm in our expression of what we believe is best for them based on their goals and our experiences. Without expressing love, we not only devalue our relationships with others but with ourselves. Daily activities can become mundane, competition can become bitter, and we can feel like insignificant individuals rather than important parts of something larger than ourselves. Certainly, no one enjoys paperwork, unnecessary bureaucracy, or losing the ability to do something one enjoys, and we should continue working to create better health care systems.
But in the meantime, I do believe we have a choice of how we react to the challenges we face and the parts of ourselves we choose to share. As a medical community, I think we can all strive to better convey love to our patients, our colleagues, and ourselves in our daily work.
Eric J. Keller is a medical student.
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