As my term as NCMB President approached last fall, I spent some time thinking about what my first words to you, my colleagues, should be. My thoughts quickly turned to a lesson learned over years of involvement with the Boy Scouts, which is the importance of having before me at all times the equivalent of a standard—the stick a scout holds before him to guide his way on a hiking trip, uphill or downhill, treacherous or easy. I decided that professionalism was to be the metaphorical “standard” I hold before me over the coming year, and that I should begin my dialogue with licensees with an article on that subject.
Commitment to professionalism is acknowledgment of the honor and responsibility we have as medical practitioners. It is unequivocal and enduring. Professionalism encompasses principles of unselfi sh concern for others, dedication to quality patient care and commitment to patient autonomy and confi dentiality. I can think of few qualities that are more essential to the competent, compassionate practice of medicine.
I want to challenge every licensee of this Board to recommit to the values stated above. In this article, I also want to share three examples of professionalism from my own life and career. I happen to be a third generation physician, so I have been fortunate to have not just one, but two examples of professionalism in my own family. I was also extremely blessed to find, during my residency training in neurosurgery, a peer whose actions have been a beacon of professionalism. The lessons learned from these three men are as essential to my life today as the many standards I have carried with the scouts over the years.
Grandfather Loomis: Care with compassion and respect
As a five-year-old in the mid-1950’s I accompanied my physician grandfather, Ralph Henry Loomis, MD, on house calls. At the time, of course, I did not know what “professionalism” meant, but I saw it in my grandfather's every interaction with his patients and their loved ones. As a physician, he interacted as easily with the president of the local bank as he did with the cook at the local diner. He was able to articulate the health challenges each faced and the choices each needed to make, always in the appropriate manner for that patient. He treated each patient as if he or she was his only patient. He sat at many bedsides carefully taking in the list of symptoms conveyed by the patients, always showing compassion and concern. I realize now that, during the early years of his practice, the best method of diagnosis was often a listening ear. Watching him was an ideal training ground for how to behave in patient interactions. I saw how he dropped his six foot frame to the floor to talk on eye level with a child. I observed as he held the older patient’s hand as he gave his advice. I noticed how he sympathized with caregivers as he gave instructions on the care to be given. He was paid for his services in farm animals, vegetables, canned goods and cash. His unselfish concern for patient care went beyond compensation.
Father: Striving for excellence through lifelong learning
My father, Charles Henry Loomis, MD, was a general surgeon who began his practice as the doctor for a manufacturing company in Benham, Kentucky. As a teenager, I stood wide-eyed beside him as an observer in his operating room, and it was there that the seeds of my own career as a surgeon were sown. My father’s young life and education were in large cities, but he saw the need for doctors in rural areas and stepped up to the plate. As a small town doctor, he was privy to the confidences of many. In fact, he likely knew more details about the people in a room than anyone else there; nevertheless, he held the confidences shared with him as tightly as the logs on a log truck are bound. My father was never board certified (certification was not available until he was well into his career) but he sought out every opportunity to improve his clinical skills. He allied himself with organizations that would require surgical data from him, to have the opportunity to objectively analyze his practice and compare it with others. Most of our family vacations were his continuing education jaunts. Through him, I saw the value of committing to lifelong learning in order to improve patients’ lives.
Practice partner: Living professionalism every day
When I entered my neurosurgery residency in 1976, I worked day to day beside a fellow resident, Lary Schulhof, MD, whom I respected and whom I later followed to the city that would become my home. This man, my eventual partner in the neurosurgery group I joined, adhered to the highest standards of patient care. He discussed with his patients all available care options, but recommended only those that he believed had a high likelihood of improving the patient’s condition. He never yielded to that frequent temptation among surgeons to think that he could produce a positive result in a patient, even when reliable data suggested otherwise. He made a conscious effort not to “ride in on a white horse.” Instead, he went at his work from the vantage point of a wise and well-trained work horse. For him, this meant explaining all risks of complications in a manner understood by his listeners. It meant answering questions as many times and in as many ways as they were asked. He was wise enough to know that he did not know everything, and never lost an opportunity to learn from his colleagues. I received many a call from him – at night, while I was on vacation – seeking my opinion and my experience. He once told me that the only bad thing about not being on call every night is that you miss half the cases. He kept a relentless schedule, yet his patience in providing care and, as a result, the number of patients under his care, abounded. Moreover, he remained humble and gracious in all that he did. I have spent my career striving to model his fine example.
Conclusion
The realities of today’s health care marketplace may make it challenging to uphold the seemingly impractical value of professionalism. But I would argue that doing so has infinite rewards. Living these values on a daily basis reminds each of us what drew us to the practice of medicine. It feeds the soul and provides a counterbalance to the stresses of dealing with insurance company hassles or fretting over how to comply with the latest government mandates. On a recent night dining out with my family, a middle-aged man came to the table and offered that, nearly 30 years ago, I had cared for his mother after she was diagnosed with a malignant brain tumor. At the time, his mother was an uninsured widow. He and other family members, who at the time had little ability to help, had wondered whether his mother would get the care she needed. I listened quietly as this gentleman, who is now a retired and highly regarded law enforcement official, told my two teenage sons that his mother did indeed get the highest quality of care, and that her bill was summarily written off by my group when her financial situation was known. He described me as “just the doctor they would have ordered.” He said that I took the time to explain his mother’s diagnosis and treatment options, that I was supportive and compassionate as those options were chosen and acted upon, and that no one would have known that her care from me was given without remuneration.
I offer this anecdote not to highlight my own actions or those of my practice group (I know plenty of others that routinely provide charity care). Rather, I mention this experience to show the real and lasting impact professionalism can have on the lives of patients and their loved ones. It was a potent reminder to me, and to my family, of why I do what I do.
As I mentioned at the beginning of this article, I’d like this column to facilitate a dialogue. So now, I’d like to hear your thoughts on professionalism. Who are your personal models of professionalism? How do you find ways to honor professionalism in your practice? Send replies to me at forum@ncmedboard.org or provide an online comment to this article. The next issue of the Forum will publish a selection of responses.
