Trust: Professionalism, Altruism, Forbearance

“Philosophy does not promise to secure anything external for man, otherwise it would be admitting something that lies beyond its proper subject-matter. For as the material of the carpenter is wood, and that of statuary bronze, so the subject-matter of the art of living is each person’s own life.”

— Epictetus, Discourses 1.15.2

It was during a particularly difficult end-of-life family discussion a few years back that I was reacquainted with just how hostile patient families can behave in the hospital environment at times. The exact details are not important now, but the near-frenzied altercation resulted in my having to alert our more-senior hospital leadership of the situation. While heading toward the C-suite, a kindly pastor who had witnessed the events sidled up beside me for the walk down “mahogany row.”

The pastor had assumed I needed consoling and was there to offer spiritual support … or so she thought. What took the pastor by surprise was my comment somewhat along the lines of: “I am always impressed by how the people who are creating the most grief for me at any point are the same people who help me to learn the most about my thoughts and attitudes.” To my surprise, the pastor seemed shocked by this type of an approach and was curious about why this was my philosophy toward difficult situations. Apparently, this particular pastor had not yet been exposed to alternatives of thought when faced with complex situations or difficult families. Consolation was a more operative approach for her.

Subsequently, once the situation settled with all parties being calmed and the institution being looked upon favorably by the family, the pastor and I settled into a discourse on professionalism as the combination of all the qualities that are connected with trained and skilled people. In so doing, we both came to appreciate how different our individual philosophies were and how they had been so strongly shaped by the professional expectations set during our respective training. It also set me up to always respect how, as physicians, we each need to listen for the differences out there and to see what can be learned from others — professional or nonprofessional.

The words “profession” and “professional” come from the Latin word professio, which means a public declaration with the force of a promise. The traditional professions are medicine, law, education and clergy. The marks of a profession:

• Competence in a specialized body of knowledge and skill.

• An acknowledgment of specific duties and responsibilities toward the individuals it serves and toward society.

• The right to train, admit, discipline and dismiss its members for failure to sustain competence or observe the duties and responsibilities.

PROFESSIONALISM REQUIRES that practitioners strive for excellence in the following areas, which should be modeled by mentors and teachers and become part of the attitudes, behaviors and skills integral to patient care:

• Altruism: A physician is obligated to attend to the best interest of patients, rather than self-interest.

• Accountability: Physicians are accountable to their patients, to society on issues of public health, and to their profession.

• Excellence: Physicians are obligated to make a commitment to lifelong learning.

• Duty: A physician should be available and responsive when “on call,” accepting a commitment to service within the profession and the community.

• Honor and integrity: Physicians should be committed to being fair, truthful and straightforward in their interactions with patients and the profession.

• Respect for others: A physician should demonstrate respect for patients and their families, other physicians and team members, medical students, residents and fellows.

— From Professionalism, by Albert R. Jonsen, PhD, with Clarence H. Braddock III, MD, MPH, and Kelly A. Edwards, PhD, part of the University of Washington’s “Ethics in Medicine” program (https://depts.washington.edu/bioethx/topics/profes.html).

Of these six areas, each strikes a chord that resonates deeply. But, for me, it is altruism that continues to provide the most resonance for continuing on the professional route chosen. By definition, altruism is the attitude of caring about others and doing acts that help them although one does not get anything for themselves by doing those acts. For whatever reason in my core psychology, altruism seems to help me in times of duress and certainly provides a sense of personal comfort even during times of success. I trust and depend on my altruism as a consistent compass bearing — a proverbial true north, if you will.

However, as we all recognize, in today’s health care industry, there is clearly much to be concerned about and so many complexities to manage among a wide range of competing priorities. Idealism is easy to speak of, and yet quite difficult to enact upon on a regular basis. Our patience and commitment to the six components of professionalism are challenged on a daily basis routinely. And many of our peers are struggling with maintaining balanced views on professional and personal issues. We are indeed in a period of time when challenges may often seem to be more common than successes.

With this complexity, there is an even greater need for each of us (younger or older) to look deep into what drives us as physicians. What drives us to be leaders in society? What makes us want to create larger change in the world? And what kinds of changes — or resurrection of core beliefs — are needed by each of us to make our chosen profession more satisfying? It’s a profession that still carries the opportunity for us to achieve that intense professional satisfaction we all know exists.

FROM TIME TO TIME, I will read about the ancient Stoic philosophies. As many will recognize, Stoicism teaches the development of self-control and fortitude as a means of overcoming destructive emotions. The philosophy holds that becoming a clear and unbiased thinker allows one to understand the universal reason (logos).

One such concept within Stoicism is that of “forbearance,” a term describing the quality of being patient and being able to forgive someone or to control oneself in a difficult situation. I bring this up in the context of professionalism and altruism because it can provide an increased sense of purpose when our own life’s compass might be wavering. Forbearance also can be used when considering the need to be patient while waiting for difficult times to pass and the return of more positive activities and influences within one’s life.

We must all live our own lives in a healthier, balanced fashion to minimize the untoward effects of this demanding profession. Giving of ourselves, while honorable and uplifting, can be draining at times. Reflecting on our core values, beliefs and ideals will help to maintain the balance needed. Forbearance helps buffer the times when we might feel a vacillation of our core.

Please don’t mistake this suggestion of forbearance as a synonym for that old catchphrase of “just suck it up, grin and bear it.” We all have already had our fair share of dosing on delayed gratification. Forbearance is much deeper. It is a philosophy (among many) that can help us stay connected to ourselves and to the worlds in which we choose to live. We all have a purpose and passion to which we resonate. The suggestion is to simply have forbearance as we each continue to seek those passions and purposes we cherish.

And for a real shift in your perspective on our importance and the need for some forbearance, take a look at this YouTube video from famed astronomer Carl Sagan: “Pale Blue Dot,” at https://www.youtube.com/watch?v=GO5FwsblpT8. The hope is that you become uplifted and energized at a deeper level while you further consider how to be a better leader — to yourself and all those around you.

LEADING AND CREATING CHANGE is our association’s overall intent, by helping to create significant change in health care through physician leadership. AAPL maximizes the potential of physician leadership to create significant personal and organizational transformation. In so doing, AAPL provides, and will provide even more in coming months, many different levels in our efforts to help build a stronger health care system — for patients, physicians and other providers.

I encourage each of us to continue seeking deeper levels for how we continue to draw upon our beliefs in the qualities of professionalism, altruism and forbearance. We can generate positive influence in this at all levels. As physician leaders, let us get more engaged, stay engaged and help others to become engaged. Creating a broader level of positive change in health care — and society — is within our reach.