Notice that it’s not exactly the “golden rule.” I specifically did not say “the way you would want to be treated.” Why? Because physicians are notorious for abusing their bodies and neglecting their own health. Doctors routinely subject themselves to stress, anxiety, insufficient rest, dangerous eating habits, and inadequate exercise.
I recall a conversation with my fellow physician Andy Weil. He was commenting on the almost universal weight gain of twenty to thirty pounds that occurs to residents during the three to six years of post-graduate training. In that same period over half of our residents’ marriages fail and end in divorce. In 1902 Osler wrote: “In no relationship is the physician more derelict than in his duty to himself.”
Andy expressed concern that there was so little “administrative attention” being focused on this physical deterioration and emotional “downward spiraling”. There was no concern about the deep-fried, fast food that residents were wolfing down between cases and the complete absence of any exercise facilities. Andy asked me: “Whatever happened to “Physician, heal thyself.” What do patients think when they see their doctors breaking every precautionary advice they just received in the examination room?”
Andy then put forth one of his principles that blew me away: “Doctors,” he said, “should be examples to their patients of how to live. They should embody the principles of wellness. They should eat properly. Exercise regularly. Work hard, even passionately. Sure. But also rest, sleep, and play—all in a healthful manner. They should practice what they preach.”
I join in admonishing physicians to treat themselves well, to become healthful.
The practice of medicine must strive to embody one central, holy, and ethical principle; namely: Love every perfect stranger perfectly. Treat every patient as if he or she were your close, beloved family member. There is no higher standard by which we can measure the quality of the medical care we provide. That is not to say we will never commit any mistakes. Consider how many mistakes each of us has made with our own children whom we love dearly. But every mistake is understandable, forgivable because it was motivated by love. The same will hold true for patients.
Imagine how our children would react if we had to explain to them that we did not send them to a better school because it was just too expensive. Or we had abruptly delegated their care to someone else “who was on call for us,” never wondering if they felt comfortable with that person.
Think about how it feels to patients or their family when, as a physician, you can look them right in the eyes and honestly say: “Here’s what I would do if you were my own son or daughter.” There’s practically an audible sigh when those words emerge, a palpable bridge establishing itself from your heart to theirs. That’s the real source of any special power physicians possess.
One of the biggest problems plaguing Medicine today is that government, industry, and insurance carriers all approach healthcare as if it were just another business. I’ve even had one healthcare executive at my own University inform me: “The principles of managing doctors and hospitals are no different than those General Motors uses to make cars or Sony to produce flat-screen televisions.”
Really? If my car or television stops functioning properly, I can get parts or get a replacement. Can the same be said about my spouse or children?
I’m aware our country faces enormous issues with healthcare, including its consumption of a significant percentage of the gross national product. Medicine is constrained by many of the same rules that apply in business, with one important exception: Medicine is the “business” of living and dying. As such it cannot be judged simply by balance sheets or rewarded with bonuses.
There’s an old saying in business management: “The behaviors you incentivize the most are the ones you will see most frequently displayed.” What incentive can be assigned to love—deep, abiding brotherly love?
An individual who decides on a career in Medicine is (hopefully) answering a calling. As such, physicians have to be judged the same way we look at someone answering a religious calling. We don’t pay clergy based on how many sins they have forestalled or how their approval rating went up after last week’s sermon. In fact, we actually support clergy with modest salaries compared with those professions requiring similarly long periods of education, training, and practice. But we also hold our clergy to a much higher standard than the vagaries of the marketplace. They have answered a calling. They are held accountable for their actions before God. As such, when a sin is committed knowingly, purposefully, it carries a taint deeper, darker than simple good or evil because it also represents a betrayal of God’s love. This is perhaps one reason that the public is so dismayed by recent revelations about pedophile priests within the Catholic Church.
By the same token, the public finds it equally appalling when some physicians or healthcare institutions exhibit callous disregard for patients’ welfare. The public feels betrayed when the medical profession cannot find a responsible method to “police” its own practitioners when they exhibit inadequate or negligent care. The public takes a dim view of how slow organized medicine has been to protect it from negligent, unqualified, even dangerous doctors.
Some of the stories in the book demonstrate I’ve no right to preach to anyone else. I’ve been guilty of misdeeds as a physician. I’m a mortal and I’ve “sinned.” I shared these accounts of my own life because I never suspected so many spiritual pitfalls existed in my profession. It was only much later in my training (some might say too late) that I discovered it was my spirit that came into question at every turn as a surgeon. My own soul would be tested. It was my own heart I had to get familiar with, to learn to rely upon it repeatedly as my guide, my compass. I know I could have been better sooner than I was. I wish now someone, a teacher or mentor, had shared that wisdom with me. I hope this book may inspire others in that direction.
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