Searching for a New Wisdom

WHAT YOU HAVE ACCOMPLISHED

The Federation of State Medical Boards’ record of civic service is exemplary. Central to your mission, and the mission of each member, is the question, “How do I do justice to patients, my profession and my community?” This noble question is constructed out of your wish to make a significant difference. When your curiosity asks, “As I do justice to myself, how do I do justice to others?” you become an elemental force in sustaining the profession’s moral identity.

How is it that one man’s, one woman’s curiosity leads to a wiser profession? Here are some examples. The Federation merits congratulations for new and growing programs. The medical literature reports you flex organizational muscle by offering an alternative vehicle for private, professional regulation.⁴

You grasp the nettle of a New Wisdom, perhaps gingerly, with ad hoc and special committees, policy documents, inter-organizational projects, as well as the Assessment Center Program of the Institute for Physician Evaluation. The list is long, including services offered through the Federation Physician Data Center.

Where did these good ideas originate? I suggest each idea arose with a particular individual asking how he/she might better approach an immediate circumstance. Here lie the seeds of a New Wisdom.

Remember that the quintessential source of curiosity is human suffering. Nascent curiosity manifests itself in, “Why did this accident, loss, cancer, illness happen to me?” Physicians experience human suffering at a remove, “How did this illness happen to my patient?” It is the source of diagnostic insight. Such disciplined curiosity makes you the respected physician you are today. I ask you to extend your questioning to our suffering profession, “How did our profession fall so far from grace?”

With that question your trained curiosity fixes on a wider field, an impaired profession. I suggest your ability to question is not limited to committee meetings or hearings but, surfaces while you are pausing for a traffic light, waiting in a cafeteria line, while soaping in the shower. Then critical questions bubble into consciousness.

Questions—good, bad or indifferent—appear as they will, awaiting your reasoning to put answers to them. Protect and save these unprompted questions, note them down, mull them over. Let your fancy play with what may at first seem impossibilities. Then, remembering that the harsh edge of nascent curiosity is best tempered with sincerity, try your unadorned musings against the thinking of compatible colleagues.

Nor is this fantasy. Your curiosity is as potent in making you a good judge as your personal values are in making you a loving parent or worthy citizen.

An example of curiosity at work is found in the 1976 experience of the Oregon Board of Medical Licensure when 8 of 40 physicians on probation committed suicide. This remarkable phenomenon remained a deplorable statistic until the question, “Why?” was asked.

Then a team of dedicated professionals investigated the life histories of the victims. The team’s answer to, “Why?” was the high degree of serious undiagnosed psychopathology existing in the unfortunate probationers prior to contact with the board.⁵ Alerted to the critical illness some probationers brought with them, the Oregon Board augmented their previous “legal” approach with a “clinical” approach that includes prompt diagnosis. Physician lives were saved by asking why.

Interest in the Oregon Board’s proactive efforts precipitated a cascade of constructive professional initiatives. The Oregon Medical Association sponsored an informal “Friends of Medicine,” enabling senior physicians to reach out to doctors ostracized for obvious personality and behavioral problems.⁶ Where once it had been commonplace for medical societies to strike from membership the name and memory of physicians who committed suicide, the AMA has put aside this destructive denial of humanity with a national study of physician suicide. Simply put, the curiosity of individual physicians has defined the profession as genuinely our brother’s keeper.

An institutional spin-off of the suicide study may catch your imagination. When asked by members of the Oregon Board what they might do to avoid future disasters, an investigator suggested the Board establish its own research capacity. Four years later the Oregon Board formed its own 501-C-3 research agency, the Foundation for Medical Excellence. Today, the foundation’s yearly budget for physician education and research is $800,000.

ACTION

Should you agree that curiosity is the catalyst for cultural change, allow me a personal question. Why does the Federation’s mission statement say nothing about the ethical basis of medicine?

“Continual improvement in the quality, safety, and integrity of health care through the development and promotion of high standards for physician licensure and practice.”

Respectfully, I ask why your mission statement lacks reference to medical morality, failing to even use the word, ethics? It leads to the strong misapprehension that you honor learning over character, even to the exclusion of character. Is this an editorial oversight or a symptom of medicine’s restrictive focus on scientific knowledge?

Does the Federation’s mission statement express a cultural prejudice of the times? If you do judge, as my curiosity speculates, that medical knowledge trumps professional behavior, your mission beclouds your vision of medical competence.

Assuming, as I do, that the Federation has broader moral ambitions than stated in your mission, how might they be expressed as goals? How might you place them in the context of the profession as a whole? These questions come down to suggesting the Federation might be curious about opportunities for publicly advancing the culture of medicine.

Should you consider altering your mission statement, be forewarned of difficulties ahead. Redefining the statement of who we wish to become demands original thinking. In effect, to change our medical culture, you and I must change our thinking about how values and principles directly express practiced vocation.

Remain aware that Board programs for civic reinforcement will be haunted by questions of how much custom and dogma dictate merit’s reward. Religious institutions wait for their heroes to die before bestowing sainthood. Nor is it difficult to understand why. Feeling the sharp probe of an original idea, religious organizations so often denounce the curious as heretics. New ethics call for rethinking old professional roles, prompting disquieting questions, such as, “Should Federation members see themselves as agents of cultural change?”

WHAT NEEDS TO BE DONE

Making a positive difference, and that is what we are about, demands moral fortitude. Engaging dysfunctional institutions takes guts. Nor can I tell you the required mix of reason and compassion demanded by “going public.” Frankly, I seek to inspire you to sweat your beliefs into reality.

Moral discernment teaches that judgment of fellow women and men is a lonely affair. Moral assertion, as contrasted to moral accommodation, is a disciplined act of will, seldom welcomed and less reinforced.

To be effective every board member should muster their creative judgment, their lonely experience in being just. Only then do you build necessary Federation strength for leading our profession to a clear sense of civic mission. Anything else is unworthy of your time.

As human beings, we share a natural tendency to think this year is little different from last, this decade little different from the last 10 years. As the days, weeks, months and years run together, like frogs accommodating to heated water, we end up swimming in a boiling culture. Incremental thinking fails to cross the present cultural divide. We need to understand how to think as much as what to think.

It takes moral strength to accept our profession as a profoundly confused social organism. We are presently suspended over a gap between 2 millennia, while torn by 2 valid, yet very conflicting ways of thinking, scientific knowledge versus experienced humanity. ^{7, 8} To be effective we must think these 2 ways simultaneously, for that is the nature of ethical judgment. Only then will we think professionally.

The Federation’s developed professional strength affords expanding opportunity to state boards to partner in protecting the public. Your example can inspire them in finding new and improved ways of service to patients and the public. More than simply offering wider ethical goals, you have the means and responsibility to breathe full life into them.

The people of your state wish to know what you are doing with the power they granted you. When you return home I encourage to open your mind’s eye and stare at how ethical values bear on your patients and fellow physicians. Belief in vocation makes us the patient’s agent beyond our hospitals’ doors. Literally, think through what your state would be like should you lack a board of medical licensure. Then, turn from that dreary view to a vision of what your state would be like with the best possible board. Keeping that in mind, step out of your office and voice your vision to your community. If we are not active for humanity, we are technicians, not physicians.

Nor are Federation members interested in doing good for good’s sake. You are dedicated to protecting the public by encouraging, sometimes forcing confused, addicted, greedy, pathologically self-centered and immoral physicians to recognize and alter their unacceptable behaviors. With an enhanced mission you can confront confused, addicted, greedy and immoral professional institutions to change their behavior. Show me, teach me how to have the moral fortitude to address today’s depersonalizing institutional threats to patient care.

I ask your help for several reasons. Of all medicine’s organizations, you stand above the prevalent cynicism of self-interest. When asked, “What is in it for you?” you can never be accused of personal gain. You cover much of the expense of serving on your board out of your own pocket. When compared with our colleagues’ present cry for personal wealth, you become the mendicant friars of the medical profession. You are blessed with organizational immunity against the virus of self-interest.

I ask your help, because you are the profession’s immediate source of moral architects in drafting a plan for an enhanced ethical house of medicine. The resources are there. You have the rational structure of the law, the tried experience of clinical practice, the beneficence of lived spirit, the excellence of medical knowledge, a refined art of medicine and the fellowship of respectful physicians. Who, better than you, know the necessary dimensions of a new and stronger structure for our vocation?

I ask much by invoking the catalyst of your creative curiosity. Imagine for yourself a professional environment that heals the community as well as patients. By thinking out your full vocation as healer, the task becomes doable. Consider building a home for medicine in which every physician finds renewed vocation, a secure source of strength and courage for the daily struggle that is the practice of medicine.