Disclaimer: this essay was written for a religious studies class at the University of Chicago called, “The Good Physician: Vocation, Calling and Clinical Excellence.” I was asked to evaluate a moral tradition and discuss what it means to be a “good physician” from that perspective. I am a Christian and read a lot of papers from Christian physician-writers for this essay, which guides many of my arguments. However, I believe and my professor believed that this paper did a good job of evaluating what a “good” physician is from a certain perspective. I and many of these writers, some Christian and non-Christian, claim that in order to be “good” we have to define goodness against a certain standard. This allows us to dive deeper into how we should behave as professionals and moreover, human beings than to simply be “professional.” This section follows after my previous post.
The Implications of Medicine as a Spiritual Practice
The talk of medical schools seeking out to correct “unprofessional” (truly immoral) behaviors has lead Frederic Hafferty and Ronald Franks to call medical schools a “moral community.” To many, it has begged the question, “Is medicine a spiritual practice?” Internist and ethicist, Daniel Sulmasy, has defined spirituality as, “the characteristics and qualities of one’s relationship with the transcendent.” To be transcendent means to be beyond the limits of experience and categories. As mortals living a finite earthly existence, we come across ideas and principles that expand beyond our life experience. Since every human has a relationship with the transcendent being, thing or idea outside of them, one might say that we are all spiritual creatures even though many may not describe themselves as being so. And, perhaps medicine is a spiritual practice.
Thus, Sulmasy calls for physicians to deepen their relationships with “the transcendent,” for in strengthening their personal commitments to that relationship, they can better meet the spiritual needs of their patients. This claim makes particular sense in the Christian tradition and not only compels Christian physicians to deepen their relationships with Christ, but to change how they practice medicine. Physicians, Farr Curlin, Sulmasy, and Alan Astrow are just some of the thinkers I will look to in discussing the meaning of Christian medicine and the implications of this meaning on medical practice. In engaging their perspectives, we can better understand the makings of a “good” physician in the Christian tradition in our analysis of motivation, role modeling, vocation and doctors’ authority to heal in medicine.
Motivation in Medicine
The growing lack of motivation in medicine and increasing physician burnout all point to a need to evaluate the current sources of motivation for physicians. Motivation arouses action toward a “desired goal;” it is the reason for action. Neda Ratananwongsa and her colleagues at the Division of General Internal Medicine at Johns Hopkins University argue that satisfaction is crucial in maintaining motivation in one’s career, but increasingly more doctors are becoming unsatisfied. What motivates doctors? They found that common “positive” extrinsic motivating factors are salary potential and job security. “Negative” extrinsic motivating or discouraging factors included debt, prolonged training, and cost of malpractice. Intrinsic motivating factors entail the desire to help others, the intellectual challenge and a sense of autonomy. Ratananwongsa et al. state that even “positive” extrinsic factors such as a high salary may not make a career in medicine more satisfying, but intrinsic factors like the desire to “help people” may promote increased job satisfaction.
Ratananwongsa and her team may call these factors, “intrinsic” but I would argue that pure intrinsic factors are often rooted in a moral tradition. There is something on the outside of us driving that need to be altruistic, “autonomous” or intellectually rigorous and this seemingly intrinsic extrinsic motivator is often transcendent. The commitment a doctor may feel after helping a sick patient may dissolve after many years of work if not cemented on a firm moral foundation. Perhaps, if doctors became more aware of who/what is compelling them (or as we will later discuss, “calling” them), they could grow in motivation and self-actualization. Evidence for this claim may be found in a study at Memorial Sloan-Kettering Cancer Center in 2000. They found that, “residents who identified religious faith as important to them where significantly less likely to act in a callous or cynical manner, to show signs of ‘burnout’ ”, but what exactly motivates Christians in medicine?
A good Christian physician is motivated to do good because God is good, and this extrinsic motivator can allow physicians to persevere when physician burnout is so common. Farr Curlin describes medicine as a gift in his article, How Shall We Then Practice? Medicine is a gift to the Christian physician because God made it, and since God made it, it is good. Therefore, ethical practice in medicine is not some neutral abstraction but a concrete way to do right. Curlin also writes that medicine is meant to give dignity to human beings who are also part of God’s creation. Jesus Christ told disputing Jewish scribes that the greatest commandments are to, “Love the Lord your God with all your heart and with all your soul and with all our mind and with all your strength” and “You shall love your neighbor as yourself”. “Altruistic” behavior, respect, and honesty are not just professional expectations for doctors on the job but demands of the Christian faith. An example of this obedience is the establishment of hospitals and ambulances in the 3rd century in the face of an epidemic in the Roman Empire. In Christian belief, true altruism is born out of obedience to God, the extrinsic motivator for doing good. In addition, it is born out of following the example of Jesus Christ when so many role models fall short.
The next bit of the essay is about “role modeling and irony” and the effect that both positive and negative role models (like Osler etc) have had on physicians for centuries. Role models can inspire us, show us poor behaviors, and incite feelings of irony. Much of this has to deal with the “hidden curriculum” in medical settings. I can share more on this later. I am giving this to you all in chunks because this paper was 15 pages long!