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Physician Title Comes With Responsibility
The word "PHYSICIAN" conjures up a variety of images. In earlier times, the image of a stately renaissance physician comes to mind. These individuals were well-read and their education was broad, allowing them to become accomplished artists, philosophers, horticulturists, musicians and poets. Their medicine was wise and patient. On the other hand, one might think of the old coot "Doc" of a rural town sitting with a bag of potions at the bedside of a sick child. A doctor in an overcrowded urban hospital in Bangladesh is yet another image of a physician. But what about the contemporary image of a pathologist seen peering into a microscope or a cardiac surgeon holding a beating heart in his hand. One might also imagine the emergency room doctor frantically tending to dozens of patients after a community tragedy, such as a 10-car pile-up or a natural disaster. In contrast, one might choose to picture in one's mind the life-affirming obstetrician bringing quintuplets into the world with a few neonatologists standing by. Whatever the image, physicians should all have a few things in common. The physician of yesterday and today is someone the community looks to for leadership and guidance, comfort and reassurance. Next to religious leaders, physicians have been held to the highest standards of ethical and moral conduct. Physicians have been privileged members of society, entrusted with details of the private lives of their patients and looked up to for guidance on a vast spectrum of issues. Physicians have been required to overcome many hurdles during training including physical exhaustion. Physicians too are not beyond scrutiny, no matter how accomplished. While young physicians are being taught to maintain those professional standards passed down through generations, reaching new physicians becomes increasingly difficult. And this foundation is often presented haphazardly rather than formally in most institutions. The boundaries between right and wrong are being blurred by the rapid pace of change that has come with technological advancements, cost-containment, increasing fear of litigation and the rising diversity of physicians through specialization. The common values of our profession fragment and lose focus. Physicians are acquiring new names and new roles. While change and progress bring much good, concern mounts over the fact that physician identity and credibility is in peril. What can be done to maintain and improve the image of physicians today? First and foremost, physicians must know who they are. Before referring to yourself as a surgeon or a dermatologist, call yourself a physician. Physicians must unite in these days of managed care and remember who they are essentially...physicians. Being a physician first binds you to the highest standards of care to each patient. Remind yourself of the personal, emotional, financial, and social challenges that are associated with the accomplishment of becoming a physician. Remind yourself of the empowerment physicians have achieved. Everywhere you look people need you. Everywhere you go, people ask your advice, heeded or not. In every clinic, shelter, and hospital in the world physicians are the indispensable element. We must not allow ourselves to be called healthcare "providers". This is not a matter of semantics. Physicians are not "employees" in the traditional sense. We cannot leave our jobs unless we leave humanity entirely. In contrast to most other vocations, we are inextricably tied to our profession. This is the image we must present to our patients. Physician licensing requirements, training examinations, and workloads have never compared to other health professions. We are not providers, we are physicians. If our identity is lost, we too, will lose the trust of our patients for our profession will meld into an indistinguishable position vis a vis other health care professionals. Full disclosure of the facts regarding medical management should be discussed with each patient we encounter. This should include financial concerns imposed on the physician by cost-containment protocols. Early and frank disclosure with the intent on educating your patients and their families will help retain the community's confidence in physicians as a whole. The loyalty of the physician should be with the patient without undermining the "business," but certainly not at the expense of the patient. We must recognize our responsibility for the image and credibility of our profession at a community level as well as the national/international level. Physicians entrust and rely on their colleagues on a daily basis. While fierce competition prevails for the acquisition of patients and referrals, this competition should not be allowed to degrade another physician's or group of physicians' identity as "physicians". Unfortunately, this process begins in pre-med and medical school with the struggle for grades and brownie points and translates into a way of life often pitting one physician against the other. Major corporations attempt to "divide and conquer" physicians in the name of the almighty dollar. We must stand up and oppose these tactics in order to avoid becoming pawns in the game of financial power. Finally, the good image of physicians can be preserved by mentoring younger physicians. Residents in-training form a large pool of young minds whose practice styles can be molded and shaped by older physicians. The training that medical students and residents do not receive should be supplemented by community physicians who continually strive to set a good example for the younger physicians in the community. It is not enough to know medical management or a surgical procedure. The qualities of true physicians temper human understanding with knowledge and wisdom. The aforementioned images of the physician appeal to humanity due to the genuine sincerity witnessed in the physician's actions, words, and practices. Most patients want to be heard. In their hearts, they yearn for the "laying on" of hands. They want to feel protected, and trust their physician to provide the best care. While many physicians are disillusioned by the changes that have come about in health care recently, their legacy will be preserved if the art of medicine is passed down honorably to new physicians. Therefore, retain your hard-won title and all it entails. Be honest with your patients and teach your colleagues well. Be a physician.
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