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Simoneʼs OncOpinion Physician, Know Thyself

2011; Wolters Kluwer; Volume: 33; Issue: 16 Linguagem: Inglês

10.1097/01.cot.0000405243.15177.f1

1548-4688

Joseph V. Simone,

Advances in Oncology and Radiotherapy

JOSEPH V. SIMONE, MD, President of Simone Consulting (Simone Consulting.com), has had leadership roles at St. Jude Children's Research Hospital, Huntsman Cancer Institute, Memorial Sloan-Kettering Cancer Center, the University of Florida Shands Cancer Center, the National Comprehensive Cancer Network, and the National Cancer Policy Board and has served on the NCI's Board of Scientific Advisors. He welcomes comments and suggestions for future topics for his column. E-mail him at: [email protected]The daily routines of life in familiar surroundings-–home, job, and family—are useful and comforting. We can drive to work without thinking much about it; the car almost seems to drive itself. Knowing a person's profession helps us sort through the many people we encounter with respect to our behavioral relationship. Meeting a physician for the first time provides an easy way to learn and understand more about that person when one is a physician herself. One exchanges information about specialty, hospital, training, medical school and so forth. But these exchanges are superficial and tell us little about what kind of physician we are, not only in the sense of how we practice medicine, but also in the more important and general sense of what kind of person we are. What values are paramount in our everyday professional activities? If we are asked that question without warning, we are likely to shrug our shoulders or answer with a befuddled, “What do you mean?” Or you might get some boilerplate response like, “Do my best for each patient,” or “The patient always comes first,” or “Give my patients the most up-to-date care possible.” These are all laudable values, but they can easily become clichés without meaning. Some physicians are very good at playing the socially recognizable role of a doctor without revealing anything about themselves as persons. More important than what we think of others is whether you or I honestly know who we are as physicians and human beings. We can convince ourselves that we are terrific physicians, true or not, because in hospitals and society in general we are often respected and admired just for being a physician; that makes it easy to bask in the belief that social stature equals one's professional competence and self as a person. Søren Kierkegaard, the Danish philosopher and probably the first existential philosopher, asked questions like: “Who am I?” What does it mean to be a person? “What should I be?” He is best known for writing 175 years ago about “self–deception in the present age” as a key factor inhibiting our ability to evaluate ourselves as persons. The “present age” he described in early 19th Century Denmark and Europe is also easily recognizable in our own age, where social status, appearing on TV, becoming a billionaire, publishing a paper, or hobnobbing with the social and political elite becomes the person one is, or better, the mask of the person one is. So how can we make an honest assessment of our qualities as physician and human being? Let's explore the easy ways first. We have a valid diploma from an approved medical school. We have a valid license to practice medicine. We fulfill our CME requirements. We have board certification in some specialty or subspecialty. We have not been convicted of malpractice or broken the law concerning controlled substances or billing. These are positive factors that governments and professional associations use to judge our competence. But you will agree that these tell little or nothing about how good a physician (or person) we are. Another way to assess ourselves is how we measure up to what patients believe are the ideal qualities of a physician. Mayo Clinic patients in Minnesota and Arizona responded to a survey conducted by Neeli M. Bendapudi, PhD, et al that identified seven basic qualities, in no particular order, as paramount (Mayo Clinic Proceedings 2006;81:338-344). The doctor should be, they found: Confident: “The doctor's confidence gives me confidence.” Empathetic: “The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me.” Humane: “The doctor is caring, compassionate, and kind.” Personal: “The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual.” Forthright: “The doctor tells me what I need to know in plain language and in a forthright manner.” Respectful: “The doctor takes my input seriously and works with me.” Thorough: “The doctor is conscientious and persistent.” These are laudable qualities that I am sure we all hope we measure up to. But all seven are open to interpretation by the patient, doctor, nurse, family, etc. And this kind of survey cannot determine professional proficiency, honesty, financial integrity, and other important factors. William Osler gave a lecture to medical students a century ago entitled, “The Qualities Required of a Physician.” He did not intend to provide a comprehensive list but he identified as most important the following: “The physician needs a clear head and a kind heart…while constantly appealing to his emotions and finer feelings.” He considered imperturbability or equanimity (“coolness and presence of mind under all circumstances”) as the top quality required by a physician. He admitted that this quality “is liable to be misinterpreted [with] the general accusation of hardness,” so keen sensibility is needed, as well. Once again, this is a valuable attribute but it is limited and easily can provide a cover for incompetence and other shortcomings. But no list or lecture can adequately determine what kind of doctor we are. It is much more difficult than that because we are the only ones who, unless we deceive ourselves, know what and who we ourselves are, what we do and don't do, in both our profession and in life. But exploring our own consciences with honesty is one of the more difficult actions we can undertake (the examination of conscience taught in my catechism classes). We are all quite capable of self-deception, papering over or blaming others for our shortcomings, making excuses, and constructing justifications. While we can certainly seek help or use guidance from a confidant, there are always facts or actions we prefer to keep to ourselves. We can search the literature for a structure for self-examination, but that may be a ploy for an easy way out and avoiding the hard and sometimes painful process of digging into our consciences. In the end, only we can do it; we must have the will to do it and to make time for it. This recalls Socrates's famous paramount maxim, “Know Thyself.” Kierkegaard acknowledged its importance and would have added to it, “Be Thyself”—that is, be honest about who you are and what you should and can be. Take a peek inside; it is a little scary but can be liberating and energizing.