Physician, humble thyself
BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4218 (Published 14 October 2009) Cite this as: BMJ 2009;339:b4218
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Yes, good food for thought, but isn't it strange how silent on this
site is that vast majority of complainers described by the author! Why
isn't someone speaking up for them?
Because they're out there alright.....I'm one of them, one of those
who these days stops in the corridor to moan about his/our lot whereas 10
years ago I stopped to have interesting conversations with colleagues
about clinical problems. And don't tell me the people who wrote all these
rapid responses are guiltless too! What this article has done is allow me
to hate myself a little and more importantly to analyse why this might be
happening.
Firstly, who would deny that in the UK at least, NHS reforms have
promoted numbers and targets whilst completely ignoring quality of
outcome? The trend is towards production-line medicine whilst doctors have
always aspired towards doing the best, the very best, for their patients.
What's worse is that we see these changes being promoted by an army of ill
-informed and often ill-educated politicians, managers and administrators.
All this corrodes pride in professionalism.
Secondly, for the past 5 years, until the financial crash, and
starting again already, we have silently watched bankers and financiers
make hundreds of millions from world financial markets. Setting aside
temptations to ask the tiny rhetorical question "What did I do wrong?",
this spectre too is corrosive across the whole of society, not least in
professionals. Its upsetting as well, because doctors are fundamentally
socialists at heart. In treating both rich and poor they have to be.
Thirdly, across the Western world, there is clearly an agenda by
governments to remove all professionals from their 'pedestals', the same
pedestal from which the author makes her observations about toll booth
collectors. In the UK, the Labour government has orchestrated attacks not
only on doctors (for example using Shipman as an excuse to beat us with
the GMC stick), but on the judiciary, on teachers and even on politicians.
Its now necessary to be a footballer or a rock star or an Alan Sugar to be
'enobled'. This, without doubt, unsettles highly trained and highly
achieving doctors.
I won't go on, but if a senior physician feels able to damn the whole
of her profession in the way Professor Frank has, then surely its only
fair to enquire as to what factors lead it to invite this opprobrium and
to its present state of restlessness. And doubtless I've missed all the
big ones!
Competing interests:
None declared
Competing interests: No competing interests
As a recently graduated medical student, I must say that cribbing and
complaining about the meager stipend that we get in lieu of working
unbelievable hours is well justified. With the passage of time, this just
becomes incorporated as a habit, when we keep on staying discontented with
whatever luxuries our jobs may offer. After all "habit is second nature"!
Here I would also like to make a comment, regarding Dr. Frank's take
on the other "lowly" professions. Granted that not everyone has the
intellectual or social or financial (or whatever else it takes) conditions
to become a doctor, but how might a cab driver feel when a doctor takes
the high moral ground and looks down on his profession to quell a bunch of
bickering colleagues by exemplifying the pitiful state of his "driven"
world? Not very happy, I would assume!
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I am an Intern, so I carry the cross medical school bestows just after passing out... bitterness!
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You said it. Probably it's same all over the world. When I meet my
colleagues in CMEs, discussions will always end up in how much one makes!!
Very few discuss the CME topic but every one is bothered about the
SEASON!! [meaning the number of patients] Most of them are
interested in how much they make, which car they bought, which real estate deals they have done
rather than how much good they are doing. Despite doing
reasonably well in life and getting adulation from society [mostly undeserved]people still crib. Most of them are there to
fleece rather questioning themselves.
Very recently a graduate asked me which was most lucrative branch of medicine to enter
after graduation, so that she can make money!!
Thanks for being so frank.
Competing interests:
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The best physicians are the most humble, as they consider the needs
of others
of equal importance to their own. They value their juniors, respect allied
professionals, champion their patients and listen to their families. Yet,
they are
only too aware of their weaknesses and are not afraid of admitting when
they
are at fault.
Competing interests:
None declared
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I am glad that Prof Frank earns more than her taxi driver (Physician,
Humble Thyself, BMJ 2009;339:b4218). Having just been charged £20 for the
15 minute cab journey to my night shift – easily wiping out my first
hour’s wages – I’m not sure the same could be said for many junior doctors
in the UK.
One thing which she does seem to have in common with many of her UK
counterparts, however, is the self-satisfied belief that her job is
somehow better than everyone else’s – a belief which is deplorably
widespread among doctors the world over. We go to great lengths to avoid
making value judgments about patients’ quality of life when faced, for
example, with resuscitation decisions. But quality of job is another
matter: we regard it as an unassailable truth that anyone who isn’t a
doctor is less fulfilled, less philanthropic and less well paid than we
are, and we pity them for it.
This conviction is far more harmful and socially divisive than the sense
of “entitlement” that Prof Frank seems so anxious to avoid. The last
thing her taxi driver needs, if his job really is as thankless, dull and
modestly paid as she supposes, is the self-congratulatory condescension of
his medical passengers. Better to stick to complaining. As Kierkegaard
wrote: “Adversity draws men together.”
Competing interests:
None declared
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Success is intoxicating. It can mislead us into reveries of pride, privilege, perks, petulance, and grandiosity. Sadly, this sometimes happens with physicians, attorneys, and public officials, who serve the public and should know better. How can this be prevented or corrected? Continuing medical and legal education should promote humility and gratitude by requiring some pro bono work for the disadvantaged in prisons, orphanages, soup kitchens, and homeless shelters. It is wise to remember that titles are not entitlements.
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I live and work in a country, where many people earn less than 2 US
dollars per day. Most of the paramedical and nursing staff take home
meagre salaries. In fact, a lot less than their counterparts in the
“developed” world. And yet, they work just as hard (if not more) as we
doctors, and probably face a lot more professional and personal stress.
Each time I am tempted to allow myself the luxury of complaining, I’m
reminded of the car park attendant who waves me through with a huge smile
or the security guard who wishes me with such enthusiasm, or the midwife
who despite her busy schedule, insists on getting me a cup of tea, because
I skipped breakfast.
That’s when I’m thankful, yet again, for the privilege of being a
doctor.
Competing interests:
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What an excellent article. It reflects my own feelings on our
profession closely.
I'd like to offer a couple of theories and an anecdote if I may:
1) Guilt. As physicians we meet people from all walks of life, with whom
we empathise. To be honest I would not swap my lot with any of my
patients, I'm not ill and I earn well. We complain to back each other up,
because to be honest all those patients do bring us down, we probably do
get some "survivor" type guilt out of it and are grateful not to be them.
By mutually complaining we cheer each other up and justify our own
salaries and good health.
2) Childhood. We are told by child psychologists that the early years of
life set patterns of behaviour and emotion that last throughout our lives.
In north America (the USA particularly) the medical student is financially
abused for years on end and then pushed into a work environment where
hugely long shifts with limited support and remuneration are not really
conducive to empathy. By stretching this metaphor and calling med school
pregnancy and early years as a doctor childhood I am not surprised that
the mature clinician may bemoan his lot while feathering his nest. If I'd
run up a mountain of debt getting qualified I'd damn well want to get paid
for it later, and I'd comlplain.
I recently attended an update course for physicians at a conference
centre. Walking towards the centre the queue looked disorderly, there was
a man wearing a studded leather jacket, another wearing a flat cap and
many were smoking. I was surprised and conflicted, half of me thought,
"bloody hell they'll let anyone in these days" and half of me thought "how
great it is to be a GP we are so diverse, I'm quite proud". Anyway it was
all moot as there was a record fair on the same day and that was the queue
I'd noticed. On the way up in the elevator (the GPs got let in first)
there was much hilarity as middle class GPs laughed at the dress sense of
the record fair crowd "not our sort at all". I felt ashamed.
Thanks again
Tom Newth
Competing interests:
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I applaud Dr Frank for writing an honest and important critique of
our profession.
I am reminded of one inspiring medical resident who said to me, with
genuine gratitude in his voice 'Medicine has done so much for me.'
Needless to say he was both liked and respected by his patients and peers.
It is difficult but pleasant to imagine the impact this attitude
would have on physicians and their patients were it to become universally
shared.
A billion people live on less than two US dollars per day. I am grateful I do not live on less than two dollars US per day.
Competing interests:
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Boxed
Dear professor Frank, With respect, but to me your article appears to
be the musings of somebody who is about to retire and who is doing mostly
academic work and not seeing that many patients in the week as a GP in
England, UK.
I speak from the perspective of family medicine in the England.
Unfortunately I believe that medicine is suffering. I feel not humbled but
forced to prescribe antibiotics for urti when I don't think it is
necessary but because of patient pressure. I am forced to refer children
to the hospital due to parents' concern. I am chased to tick the tick
boxes for conditions or to exclude conditions and to make copious notes
that look like a page from www.bestpractice.bmj.com or otherwise spend
evenings drafting letters to the medical defence.
Every fever in the UK is now Swine Flu. It is not medicine anymore.
It is about following a flow chart and indeed GP doctors are not that
needed anymore. This is growing out of the prevailing scientific point of
view, as covered by articles in the medical (scientific) journals. In that
scientific - numbers orientated view, people in future can hopefully be
referred to NHS self-tick-box-websites to assess whether a medical opinion
is needed in secondary care and primary care will probably be catered for
by clerical staff, trained to tick the boxes of www.bestpractice.bmj.com
Numbers are taking over the human being.
I think the issue with the examples of the doctors in your story is
not to feel humble but to reflect what made you choose to go into medicine
for and, like William Osler said, to focus on what we can add to life, not
what we can get from life. Foremost family doctors should be aware how
medicine is getting boxed in. Academic people should not be sentimental
about this but show some creative, artful thinking and bring healing back
into the scientific box.
Competing interests:
None declared
Competing interests: No competing interests