Reflections on ourselves, our patients, our profession

A message to all physicians from Steven J. Stack, MD, chair of the AMA Board of Trustees, on a physician's dual responsibilities to patients and profession.

By — Posted May 13, 2013.

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“We make a living by what we get, but we make a life by what we give.” Winston Churchill

My father-in-law concludes an annual Christmas letter to his family with that quotation. They aren't just words on a page, though. In that same letter, he also reveals the details of the annual family vacation he has arranged for the upcoming summer. Quality time spent with family is such a priority for him that he personally ensures we all spend that time together apart from the hustle and bustle of our daily lives. I can't think of a better example of “walk the talk,” and my father-in-law has certainly driven home for me the meaning in Churchill's words for our family.

Churchill's words also have relevance for us as physicians. In this regard, I am not referring to uninformed altruism but, rather, a conscientious commitment to the welfare of others with full knowledge and free acceptance of the challenges this entails.

In my columns during my year as chair, I have attempted to highlight some of our profession's nobility, convey a shared sense of frustration (at times even outrage) with the inadequacy of our current health system, and instill some hope that both individual physicians and our AMA can make things better for physicians and patients. I hope these communications have provided some assurance that AMA leadership understands the obstacles physicians face and is aggressively at work to mitigate them where we are able.

With full awareness of the vexations and difficulties we face as physicians, I challenge each of us to make a conscious choice to persevere in the face of that adversity and draw strength from the unparalleled privilege we enjoy to enter into the lives of others and affect those lives so very profoundly, often indelibly.

Yes, we have legitimate gripes and sincere worry for our own futures. For me, though, when I step back from my immediate frustrations with practicing 21st-century medicine, a shift in the emergency department reminds me nearly every time just how fortunate I am.

As we work as physicians, we must not lose sight of the fact that we are simultaneously working on behalf of each other. We must remain doggedly engaged, persistently constructive and consummately professional. I am mindful of the words of a prior AMA board chair whose father told him as a child, “Remember, when you leave this house, you represent the entire family.” To every physician, I share that same advice here — remember, every one of us represents the entire profession.

Knowing I had to write this column tonight, I did what any responsible person would do — I went out to my favorite sushi restaurant instead. With my wife and daughter at a Taylor Swift concert, the night alone was just too valuable to spend at the computer! Remarkably, fortune dealt me the right hand and the inspiration for my writing.

The restaurant was packed. Against an unrelenting crush of orders, two sushi chefs worked with astounding efficiency and a surgeon's precision to deliver consistently beautiful plates, one after another. Though admittedly with very different implications, they reminded me of being in the emergency department during crunch time, and I couldn't help but be impressed by their skill and calm confidence as they diligently worked through their daunting backlog of orders.

When not watching the chefs, however, I read the April 24 issue of The Journal of the American Medical Association. If you haven't seen it, I encourage you to turn to Page 1,695 and read “One Last Teaching Moment” by H. Esterbrook Longmaid III, MD. I won't tell you what it's about — maybe this is the time for you to try the new JAMA Network Web app (link). But I suspect that when the sushi chef asked me if I was OK, it was because he saw tears in my eyes, not because my plate was empty.

When I fall short of my own expectations of myself as a physician, others such as Dr. Longmaid help me remember the times I've shared his experience, those times when I did rise to the occasion, and they inspire me to be mindful of my responsibility and thankful I have the privilege to be a physician. They remind me that I represent the entire profession, and I have an obligation to the profession to represent it well.

We have a need — even an obligation — to attend to the practical challenges of science, law, politics and finance that are inextricably woven into the work we do as physicians. But although the challenges we face are many and substantial, fostering the health and well-being of our fellow men and women is a worthwhile and noble cause. Our attention to the humanism of our work remains the most important gift of ourselves to others.

For millennia, physicians have freely accepted the awesome responsibilities associated with our healing profession. In turn, society has granted us uncommon trust, respect and security. If we preserve our moral compass and keep our attention on our service to others, history has shown that over time, all the other day-to-day worries take care of themselves.

In the pursuit of that noble cause, I remain confident that physicians will continue to demonstrate that we make our lives by what we give, not by what we get.

As my year as your chair now draws to a close, I thank you, with gratitude, for the lives you have made giving so much of yourselves to our patients and our profession.

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