Preoccupation with doctors

The beginning of a new year is usually a time for reflection. While personal reflections are private and idiosyncratic, professional reflections tend to be public and collective, and doctors have recently been subjected to unprecedented public scrutiny.

We are exhorted to pursue integrity, compassion, altruism and excellence, and to work in partnership with members of the wider health care team. We have been scrutinised by working parties of the Canadian Medical Association and Canadian clinical Colleges; the Royal College of Physicians (London); and a combined body of the European Federation of Internal Medicine, the American College of Physicians–American Society of Internal Medicine and the American Board of Internal Medicine. The Royal Australasian College of Physicians has also recently released a Code of Professional Behaviour.

The essence of their reports is best captured in the words of the US physician Christine Cassel as being related to: “self-governance individually and as a group; service to the poor without expectation of compensation; deliverance of quality; not ripping people off; high level of learning; autonomy of activity; altruism with a certain threadbare nobility; self-sacrifice; heroism as needed; and ethical practice with public accountability”.

Add to all this the need for doctors to have essential character values,* such as an understanding of history; an appreciation of literature and the arts; honesty and personal integrity; the grace of humility; faith in life’s meaning and value; compassion; an appreciation of the virtue of work; and willing submission to an ethical code.

Remember the fabled Martian, who when asked at the midpoint of the 20th century “Whither medicine?” replied: “Why, whither else than straight ahead; forging still more weapons with which to conquer disease”. Were he to visit us today, would he not ask: “What is going on here? Why all this intense preoccupation with professionalism in the face of medicine’s stupendous advances?”