The Privilege of Caring

Editor's Note

Dr. C. Barber Mueller is Professor Emeritus of Surgery, McMaster University, Hamilton, Ontario, Canada. These remarks were given at a special class dinner for the second year medical students. The assembly gave Dr. Mueller a standing ovation at the end of his talk.

Dr. Mueller is a product of the surgical training program at Washington University School of Medicine and Barnes Hospital, St. Louis, Missouri, and spent 12 years researching and writing a landmark biography of his mentor, Dr. Evarts A .Graham, which was published in 2002. After 11 years (1956-67) as Surgical Department Chair at State University of New York at Syracuse, NY, he took a position as Chair of Surgery at the newly formed McMaster University. He was attracted there by the opportunity to revise and improve the traditional teaching of medical students. Their program was one of the first in the world to stress problem-based learning. Dr. Mueller’s lifelong interest in and contributions to the knowledge of breast cancer have been instrumental in revising the treatment for this disease. Dr. Mueller can be characterized as a surgical innovator, a medical educator, and, as this essay demonstrates, a true humanist.

Thomas B. Ferguson, MD

To medical students everywhere:

At the dawn of your medical career and the twilight of mine, I feel obliged to reflect upon the unusual privileges that society accords to our very special profession.

After your time in medical school has introduced you to the world of the sick, you will enter an elite and fascinating world. By surviving thus far, you have not only demonstrated an interest in medical science but also that you are intent upon a serious career in caring. A long history of many traditional medical guidelines to help you to give this care and practice judiciously in your chosen field are contained in the several ethical codes of conduct that have been fashioned by our profession and are now supported in courts of law. Short and cryptic, these ethical statements are worth reading, understanding, contemplating and remembering for they underpin our heritage and govern not so much what is done but specify the goals of doing and the reasons for our being. Medical misconduct usually occurs in the area of social behavior and reflects an ignorance or abjuration of decent, upright, and honest interpersonal values. Rarely is ignorance of medical knowledge considered misconduct.

Although these words may seem to come lightly, they carry a heavy message about you and your chosen field which will shape you as you are shaped by it. As a member of the health/medical profession you will receive many privileges from a society that expect you to serve it with trust and confidence. The grocer, shopkeeper, policeman, teacher and your non-professional acquaintances will defer to you and grant special favors just because you are a “doctor”.

Most of you will be in clinical practice – that is, you will care for patients – young and old, sick and not so sick, or even those who make up the worried well. As clinicians you will touch, feel, and give care to others as you tend their illnesses and assuage their sorrows. Some of you will be in clinical laboratories or in research on the periphery of direct patient care; but all of you will be members of the HEALTH profession, one of the four noble professions alongside JUSTICE, TRUTH and VIRTUE (law, education, religion). The health profession is different from the other three in that it involves the touching of human beings – not just their bodies, but also their minds.

For the truly caring physician this may be an uplifting experience and a rewarding way of life, since society will trust you with its collective bodies and to some extent its collective minds and does this with extremely high and often unreasonable expectations as to both process and outcome.

Benefits in this profession are bilateral; they go to you, the giver, as they do to the patient, the receiver. At first thought they may seem to be for the patient, but they also become yours for doing the caring. You will be judged more on how well you care than on how well you cure. The well-being of others must always be the object of the effort; remember that well-being to a patient is personal, physical and emotional as well as medical, and should always come before the well-being of self. Chiefly, benefits are measured by the quality of life of others – a difficult measure – and they are not to be found in your personal bank account, the size of your home or in the academic or research honors you may accrue. You will experience your benefits from the sense of satisfaction that comes from caring for others, from your membership in an elite group, and from your association with like-minded people who are curious, well-educated, articulate and informed. However, these benefits carry risks for you may become rigid, opinionated and dogmatic since in the eyes of a patient it is a physician’s obligation to be correct, certain, and up-to-date. These expectations carry a burden for which you must be prepared by coming secure within yourself and by accepting your errors – often due to inadequate information – that will inevitably occur when making decisions regarding ill patients, errors that will be felt by others, not by you. Recognizing, acknowledging and being comfortable with your errors requires thoughtful insight, critical analysis of self and a great deal of personal, emotional security.

As a neophyte physician in the process of acquiring your particular set of skills as well as the knowledge and attitudes that will reflect the responsibility resting on your shoulders – you will finally receive an M.D. degree and later become licensed to practice medicine.  Once licensed, you will be permitted to stick people with a needle, cut them with a knife, poke, punch, and probe into their body orifices. You will be permitted to enter the homes of strangers – their bedrooms and bathrooms - and to touch the unclothed and the unwashed. You will be given permission to administer drugs that by law are prohibited to others and you may explore personal habits, life styles or sexual preferences as you probe into family and social interactions. You may even delve into thoughts of suicide or murder.

All of these actions constitute assault and battery, the invasion of privacy and violation of body or mind of another; they would be criminal offenses if committed by someone unlicensed or uncertified and could lead to prosecution and jail as felonious acts. Through its governing agencies – province or state – our society has developed license and certification laws that authorize, support and defend you in these activities and these statutes go so far as to permit you to perform them in secret under the rubric of patient/doctor confidentiality. As well, there is a tolerant accountability system that is built on trust – trust of doctors – trust of you. However accidents do happen, misadventures do occur and patients do suffer or may even die from misjudgments, yet all of these actions are outside the criminal code. The law protects the doer – you – when you act with anticipated benefit to the patient and when you are so trustworthy that you recognize and do not exceed the true measure of your capability.

These are very special privileges. Do not see them as a burden, but be aware of the heavy responsibility that comes with the special role you play in exercising them. Society set you and your colleagues apart from everyone else. Please do not let the practice of medicine become such an obsession, so commonplace and so commercial that you forget their origin, for occasionally someone is tempted to sue these privileges for self gain and if this happens it may bring legal troubles. However, the greatest penalty occurs when a physician loses the purpose in life that come with helping others less fortunate. Money is not an equivalent.

As you enter this world of the privileged few, you will be honored so long as you uphold the highest traditions of our profession. It is not a business; it is a calling and a life of caring. I am pleased to have been a part of this life and a member of this class of privileged people in the special world of caring for others. I can only hope that you may become as enriched and fulfilled as I have been enriched and fulfilled. So keep your aspirations high, your vision clear and your eyes on the stars. Above all, keep the faith.

Publication Date: 6-Dec-2005
Last Modified: 2-Jul-2008