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Saturday, April 30, 2016

Transformation from "layperson" to physician

In the ten  years since I began blogging  much  of what has been written about medical professionalism, I find alarming. The New Professionalism  as promulgated by the American College of Physicians and the ABIM attempts to transform the basic medical obligation of the physician to the patient to a nebulous,operational vague co-duty to serve society by conserving resources and furthering social justice.

The following is taken  from an earlier blog entry with light editing and additions.

Dr. Lawrence G.Smith, writing in the April 3, 2005 issue of the American Journal of Medicine speaks of this transformation. from lay person to physician. Professionalism has been written about extensively as it relates to doctors. Smith maintains the core of professionalism is the "personal transformation of self that takes place in stages during the early years of medical training and practice" When transformed the person now interacts with society in a new and different manner ).Dr. Smith was not speaking of professionalism in terms of being a steward of collectively owned resources,that distortion of basic medical ethics was not  then widely written about.

I have no doubt that transition happened to me. I can still remember comments made by teachers now over 50  years ago which were part of that process. I remember the attitude of respect and seriousness that was passed to me from the professors of gross anatomy as it related to behavior to the cadavers and behavior in the lab. I remember the pathology professor who told us that when we saw patients at night in the hospital how important it was for us to look and behave like physicians.I remember the chief of surgery who insisted that his residents wear shirts and ties in the hospital and clean coats and that his definition of a surgeon was a physician who knew how to operate.I remember how the clinical faculty typically treated the patients in the county hospital always with courtesy and respect, even though at times residents might have not.

 Soon after I completed residency and fellowship training I was doing a locum tenens and had the occasional to call the chief of medicine, with whom I had trained, to see a private patient at 3 am. She had end stage lupus and he had seen her several years before and her parents insisted that he see them. I called him at home and  he arrived soon after .. He was well shaven and well dressed in a suit and tie.. He spent over a hour with the patient and family,taking a detailed history and ding a physical examination , completed a page and half note and spent another 10 minutes with me.The family was greatly relieved that all that could be done was being  done. I was greatly relieved and felt that the chief had taught me another lesson;how a physician can do things the way that should be done in the real world.

These are just a few snap shots of the many  events and attitudes that lead to my transition from a college kid who really had no idea what to expect in med school or beyond to a person who felt he was trained to do serious, often difficult, important work and that it all was a privilege and a great obligation and that doing the right thing for the patient was what it was all about. Much of what my high school friends had done while I was in training, I had missed and in the years of training much of transpired in the world I had also missed. And much of the everyday concerns of relatives seemed to be so much less important.I believe part of that transformation process is the isolation from the daily events of the world that seems required by the intense study and training lasting for years past the usual time an adult joins the work force. Part of that transformation occurs because most of your waking hours are spent with other physicians and professionals doing what doctors do and talking about things doctors talk about.Role models are everywhere.

I might add  my classmates and I made that transition with the "benefit" of the trophies- for- everyone -before- the- game white coat ceremony.

As Dr. Smith said, once the transformation occurs you cannot think of being a physician as just a job.And it is difficult to think of yourself as any thing but a physician.

And because of that transformation it becomes very hard for a physician to retire or to be forced to leave practice because of illness. Are you transformed back into a lay person or are you still a physician who ...?

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