In 2005 the Royal College of Physicians of England published a milestone document entitled Doctors in Society: Medical Professionalism in a changing world. Of this 69 page document, that has been used extensively round the world to redefine medical professionalism, they make this summary:
“Medicine is a vocation in which a doctor’s knowledge, clinical skills, and judgement are put in the service of protecting and restoring human well-being. This purpose is realised through a partnership between patient and doctor, one based on mutual respect, individual responsibility, and appropriate accountability.”
They go on to list the six attributes that count most in professional practice:
integrity, compassion, altruism, continuous improvement, excellence and working in partnership with members of the wider team
The summary concludes:
“These values, which underpin the science and practice of medicine, form the basis for a moral contract between the medical profession and society. Each party has a duty to work to strengthen the system of healthcare on which our collective dignity depends.”
A few years ago I was having a conversation with a young pre-clinical student in an East European country. She was telling me of her excitement about eventually becoming a doctor, describing how her desire was to help the sick and bring them comfort. I asked her if others in her year felt the same. She replied that most of her friends also felt this way. I told her to try never to lose this idealism. She assured me that she and her friends never would. I then asked her how many of the doctors that she met and worked with appeared to feel this way. She thought a few moments and then she shook her head sadly and said, “Almost none. What happened to them?”
What happened indeed? When we ask any group of first-year students, from almost any country, faith or culture, why they have chosen medicine, or indeed any other health care profession, phrases such as wanting “to make a difference”, “to help people” usually occur alongside wanting the excitement of the emergency room (who said a vocation had to be boring?), fascination with the science of the human body and other motives (some more laudable than others). But somewhere along the line, all too often disillusionment and cynicism creep in.
I want to draw attention to the use by the College of the word vocation. Search Google for “medicine as a vocation” and you draw down around 40,000 references. Literally it derives from the latin vocare to call and so is a calling, historically having implications of a calling from God. A couple of years ago, I was privileged to be a guest speaker at the first national conference on mental health arranged by the Nepal Association of Psychiatrists. Prof B K Singh, adviser for the Government of India, addressing the 130 or so doctors, nurses and students there, concluded his opening address with the words, “We must all remember that God has appointed us as his agents to bring healing to the people.” My main presentation was on Therapeutic Relationships – the Healing Power of Compassion. Thereafter, speaker after speaker, Hindu, Buddhist, Christian referred to this divine appointment by God as the source of the compassion needed for such healing.
However, not everyone has such belief, but even so the report used this word, rather than ‘job’ or ‘occupation’ to refer to the sense of service that motivates most of us into the caring professions in the first place. Whether you understand the call as coming from God or from the altruism the report refers to in your own heart, it is still a calling – a vocation.
Quite some years ago, partway into my professional career in family medicine, I felt burned out. The ‘calling’ had become a job and one in which I was struggling to keep my head above water. I was pretty successful – I had quite rapidly transformed a small practice into one of the biggest in the town, I had an above-average income, a good house, a delightful family, friends. I had become a leader in the local church and was active in affairs of the town. But it was a struggle. I became afraid of making a mistake in case my reputation was damaged, I double checked all my prescriptions, lay in bed at night worrying – even worrying about money although I had no need to.
Then one day in a training of trainers event I was involved in, one of the other tutors suggested we all drew a picture of how we saw ourselves that afternoon. I drew myself juggling balls whilst standing on a swaying raft on a sea full of sharks. I looked at the balls I had drawn and saw they represented friends, family, church and money – all good and necessary in themselves – then I realized there was something not there. I drew another one – idealism – the reason I had gone to medical school, the reason I had worked for years as a medical missionary in the Himalayas. Somewhere I had lost it. There and then in the post-graduate centre, I would say I found God again; some might just say I found again my reason for living. Whatever, next day I entered my clinic with new confidence, no longer resented the dozens of patients who wanted to see me, instead of seeing them as “work”, feeling the privilege that people would trust me with their health, even sometimes their lives. I took more joy in my family and friends. I had, as the Bible says, “remembered my first love.”
So, whether you felt called by God or just your own inner being, may I say please don’t forget your calling, whatever idealism brought you into the healing professions keep the flame burning bright. Remember the thrill of the first patient who recovered because you were there, the first time someone looked at you and said, “Thank you”. And if it has grown dim, then invite it back into your life.
Dr John Geater, MBE.
PRIME International Director.
Report of a Working Party of the Royal College of Physicians (RCP) of London. Published by RCP, December 2005. ISBN 9781860162558.