By JOHN RHEE, MD
In the past few weeks, I have seen a lot of heroism from my colleagues. Just the other day, an email went out asking whether people would be willing to volunteer extra shifts in the hospital, should the worst situation happen where a large part of the staff could become either sick or quarantined from the coronavirus. Immediately, I saw the Google Spreadsheet fill with names, despite the fact that we already work close to 80 hours a week, some of those being 28-hour shifts. Yet, I continue to see my fellow residents step up for each other.
However, there is another emotion that is palpable and spoken about openly: fear. For the first time in our medical careers as trainees, we have come within arm’s length of a fairly unknown infectious disease, with mortality estimates ranging from one to as high as four or five percent. And each of us has heard of at least one young person in a critical care unit from the virus. Furthermore, given we are working in the medical field, we are also acutely aware of the fact that we are among the high-risk groups (the six-feet rule is impossible when you are trying to assess when someone is having a stroke or not), and we know there are doctors who have contracted COVID-19 in critical condition1. Though we entered this field knowing that there were to be risks involved, while studying for Step 1, that reality was less imminently tangible.
So, is medicine really that unique? It is a question that I have been struggling with during residency. I felt called to medicine to help the sick, to accompany the dying, and to gain a skill in which I could help those least fortunate in society. Though I would like to still say that my idealistic vision of medicine has not changed, I have been troubled by a system that seems overly focused on revenue value units (i.e. how much can the doctor make in for the hospital per service provided), a forgoing of justice in the differential treatment for the rich and the poor, where the business interest of hospitals and insurance companies often trump the good of the individual, and where more and more pressure is placed on the doctor to produce, in procedures, clinic visits, articles, lectures… and the list goes on.
However, history does show us that medicine was, indeed unique. It was a profession, which historically only included certain types of jobs, among them, physicians. The word comes from the Latin professionem, which was a “public declaration” that one took when giving up all worldly things to take a vow to enter a religious order. It was considered a “calling from God”, and, over time, the term profession was used to include very specific societies of individuals called to a special responsibility to a learned science or art and its application in the well-being of others.2
And medicine seems to not completely have lost that purpose, yet. Though medical admissions essays have come up with more and more creative stories of why an individual may want to enter the profession of medicine, the large majority, I am certain, if given the opportunity to give a less-than-five-word answer that would not affect their likability to an admissions pool, it would be “to help other people”. Therefore, when I saw my co-residents rising to the call, literally placing their lives at risk for the service of others, I felt moved.
But I also knew that there is something we are missing. Physicians continue to report burn-out at high rates, and I have personally known people in medicine who have committed suicide4.
Still, I felt that the current pandemic was giving us an opportunity to rediscover something deeper about the meaning of our profession. The pace of medicine has continued to quicken as more and more patients need to be seen, in shorter periods of time, mostly driven by profits. (I think the best reflection of that quickening pace is the evolution of how quickly I can inhale my lunch with each passing year of medicine.) But the current pandemic is, for once, giving us an opportunity to slow down. It has forced us to cancel elective surgeries, empty our clinics to only the most essential visits, and triage only the sickest patients to the hospital, in order to keep those most vulnerable from contracting the disease.
I think it is here that we can more fully discover the purpose of our profession and to re-reflect on our own individual motivations for choosing medicine in the first place. I do not claim to understand fully the purpose of medicine, and I defer to those who have come before me. But I cannot help but think that the current distress and panic has opened up a moment that we should grasp, hold, and ruminate on, and not to treat it as another interesting journal article that catches our interest one minute but is quickly discarded for another. Why am I willing to risk my life for patients I have not yet met? Should I? If so, what drives me to do so? Is it purely my pride or is it my sense of responsibility? Or is it something deeper, a professionem? I think the answer may lie in trying to answer some of those moral questions, rediscovering that, at its core, medicine is a moral profession, and we, as a profession, need to rediscover what that means and why it is so important to the future of the profession itself. We are not and cannot simply driven by rewards or profits, we are answering a deeper moral call. And who is doing that calling (society, the profession itself, or God), I think, is an even deeper question that I do not attempt to touch upon here.
As one of my role models in medicine, Edmund Pellegrino, once said, “To be a professional is to make a promise to help […] in the best interests of the patient. It is to accept the trust the patient must place in us as a moral imperative, one that the ethos of the marketplace or competition does not expect us in our society to honor. The special nature of the helping and healing professions is rooted in the fact that people become ill and need to trust others to help them restore health.”3 Perhaps the forced slower pace can give us the space for interior and exterior silence, and to rediscover what it means to establish this covenant as healer with those who are suffering.
- New York Times. Two Emergency Room Doctors are in Critical Condition with Coronavirus. March 15, 2020. https://www.nytimes.com/2020/03/15/us/coronavirus-physicians-emergency-rooms.html
- Sir J.A.J. Murray, editor, New English Dictionary (Oxford: Clarendon Press, 1909).
- Pellegrino, E. What is a profession? J Allied Health. 1983:12(3):168-176
- Medscape National Physician Burnout & Suicide Report 2020: The Generational Divide. January 15, 2020. https://www.medscape.com/slideshow/2020-lifestyle-burnout-6012460
John Y. Rhee, MD MPH, is a neurology resident at Massachusetts General Hospital and Brigham and Women’s Hospital and a clinical fellow at Harvard Medical School. He is interested in medical ethics, and is a member of the Pontifical Academy for Life in the Vatican.