Keep the Flame Burning The Vocation of Medicine

Keep the Flame Burning: The Vocation of Medicine and the Crucial Role of Physician Leaders in Mission

Thank you! I owe the doctors here so much both personally…and as a representive of the Sisters of St. Scholastica Monastery

Dr. Peter Bartzen and the first lay board of the College of St. Scholastica

Dr. James Mongé, President Larry Goodwin and other members of the College of St. Scholastica Board of Trustees

Obviously we could not have provided health care without the doctors who helped us to found the hospitals we ran This is the staff of St. Mary’s Hospital in 1925

Doctors in St. Mary’s Medical Records Library ca. 1932 An early instance of cooperation and collegiality across systems: the Blue Cross 8 th Anniversary, April 1, 1946 Dr. Edward Tuohy, Sr. Patricia Thibodeaux, James Mc. Nee, Superintendent of St. Luke’s, and Mary Danis of Blue Cross

The vocation of medicine I, like so many of those who filled the first ranks of family practice, often described my career choice as a calling, a vocation, something more than a meal ticket. It was a source not only of pride and conviction but also resentment and resistance to change. – David Loxtercamp, MD in “Eulogy for my Vocation, ” Annals of Family Practice, vol. 7, May/June, 2009

St. Luke’s Organizational Values Essentia’s Organizational Values These values provide the foundation of our culture as we pursue our mission and vision: • • • The patient comes first Quality is our expectation People make it happen Everyone is treated with respect Quality Hospitality Respect Justice Stewardship Teamwork Our highest priority is the people we serve. • We believe that the highest quality health care requires a regard for both the soul and science of healing and a focus on continuous improvement.

Based on our values, you are committed to interaction in your care for the patient – you don’t want to be “Schnabel Doktors. ” The Schnabel Doktor would wear the beak mask filled with herbs to visit plague patients. The herbs would mitigate the odor and also were believed to guard against the contagion. Just in case, the Schnabel Doktor would keep at a good distance, only touching the patient with the rod. Schnabel Doktor

This physician also keeps his distance flinging herbs safely away (or so he thought). Image from the Toggenburg-Bibel, 1411 AD

This style of medicine was not only a Western European issue as is seen in this 15 th c. depiction of a Persian Doctor.

“The good physician knows his patients through and through, and his knowledge is bought dearly. Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient. “ –Francis W. Peabody, MD in his address to Harvard Medical Students in 1926

TIME Time – lack of time, time filled with required tasks that preclude our preferences, finite time – haunts all of us

Dr. David Herman: “In medicine probably more than in any business I see we have systemic disrespect… It’s just the way we’ve designed our business” from a talk about the value of respect during Grand Rounds

Dr. David Herman: Disrespectful working conditions lead to disrespectful behavior: • • • Long hours Heavy workload Inequitable distribution of time Clunky electronic record systems At the mercy of circumstances beyond our control Spiraling effect of disrespect

"As we grow in learning, we more justly appreciate our dependence upon each other. The sum-total of medical knowledge is now so great and wide-spreading that it would be futile for one man to attempt to acquire, or for any one man to assume that he has, even a good working knowledge of any large part of the whole. The very necessities of the case are driving practitioners into cooperation. The best interest of the patient is the only interest to be considered, and in order that the sick may have the benefit of advancing knowledge, union of forces is necessary. " This could have been written yesterday but it comes from Dr. Will Mayo

Dr. Will Mayo possessed great insight into the sacredness of a physician’s vocation as seen in the following quotes: “Perhaps the ability not only to acquire the confidence of the patient but to deserve it, to see what the patient desires and needs, comes through the sixth sense we call intuition, which in turn comes from wide experience and deep sympathy for and devotion to the patient, giving to the possessor remarkable ability to achieve results” “The hospital should be a refuge to which the sick might go for relief as they went before our Savior, …”

Dr. Martin Henry Fischer (1879 -1962) Lecturer in Physiology for over 40 years at the University of Cincinnati Photo of the portrait which hangs in the University Library

“Fischerisms” A doctor must work eighteen hours a day and seven days a week. If you cannot console yourself to this, get out of the profession. Probably his most quoted remark, often used with beginning medical students

“More Fischerisms” …but Fischer also said. . Observation, Reason, Human understanding, Courage: these make the physician. A doctor is a man [or woman] possessed of such qualities that people turn to him instinctively to help them solve their problems, both material and immaterial.

Never doubt your authority This medieval patient was desperate enough to be willing to submit to whatever surgical procedure is going on here – the smiles however are artistic convention, not an indication of enjoyment (I hope)

This patient is undergoing cautery treatment. Cautery points were similar to acupuncture points, only the physicians used red hot rods to burn into the flesh rather than needles. Think of the trust and respect a patient must have for you to make them willing to undergo the painful and difficult treatments recommended today, like chemotherapy or surgery. (Never mind the times they quote Dr. Oz – or worse).

In the last 50 years, the culture of the hospital has changed from one where every time a physician passed a nurse’s station, everyone stood up to one where physicians often feel marginalized in the care of the patient.

Consider the following quote from Martin Fischer. The classic picture of the doctor will come to you chiefly by word of mouth and through example in your colleagues… I suggest that you look up the oath of Hippocrates in literal translation and throw out that brought up-to-date by the revision committees. Then read the prayer of Maimonides and the Enchiridion medicum of Hufeland. After that if you’re not tired read the condensed version of the later by Koan Ogata, translated by Shiro Tashiro. The gold comes out quite pure.

HIPPOCRATIC OATH, MODERN VERSION I will reverence my master who taught me the art. Equally with my parents, will I allow him things necessary for his support, and will consider his sons as brothers. I will teach them my art without reward or agreement; and I will impart all my acquirement, instructions, and whatever I know, to my master's children, as to my own; and likewise to all my pupils, who shall bind and tie themselves by a professional oath, but to none else. I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow. With regard to healing the sick, I will devise and order for them the best diet, according to my judgment and means; and I will take care that they suffer no hurt or damage. Nor shall any man's entreaty prevail upon me to administer poison to anyone; neither will I counsel any man to do so. Moreover, I will give no sort of medicine to any pregnant woman, with a view to destroy the child. Further, I will comport myself and use my knowledge in a godly manner. I will not cut for the stone, but will commit that affair entirely to the surgeons. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug. I will not be ashamed to say "I know not, " nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

HIPPOCRATIC OATH, MODERN VERSION Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient; and I willingly refrain from doing any injury or wrong from falsehood, and (in an especial manner) from acts of an amorous nature, whatever may be the rank of those who it may be my duty to cure, whether mistress or servant, bond or free. I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God. (rather ironic that this was added even as the parts of the oath banning administration of deadly drugs and abortion were removed!) Whatever, in the course of my practice, I may see or hear (even when not invited), whatever I may happen to obtain knowledge of, if it be not proper to repeat it, I will keep sacred and secret within my own breast. I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick. I will prevent disease whenever I can, for prevention is preferable to cure. I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm. If I faithfully observe this oath, may I thrive and prosper in my fortune and profession, and live in the estimation of posterity; or on breach thereof, may the reverse be my fate! If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

The Oath of Maimonides The eternal providence has appointed me to watch over the life and health of Thy creatures. May the love for my art actuate me at all time; may neither avarice nor miserliness, nor thirst for glory or for a great reputation engage my mind; for the enemies of truth and philanthropy could easily deceive me and make me forgetful of my lofty aim of doing good to Thy children. May I never see in the patient anything but a fellow creature in pain. Grant me the strength, time and opportunity always to correct what I have acquired, always to extend its domain; for knowledge is immense and the spirit of man can extend indefinitely to enrich itself daily with new requirements. Today he can discover his errors of yesterday and tomorrow he can obtain a new light on what he thinks himself sure of today. Oh, God, Thou has appointed me to watch over the life and death of Thy creatures; here am I ready for my vocation and now I turn unto my calling.

Koan Ogaku (19 th c. Japanese physician): The physician lives not for himself but for others. This is the essence of his profession. Do not look for fame or profit. Work to save others though you lose yourself. Maintain life, restore the sick and ease suffering… Excerpt from the Tashiro translation quoted by Hideki Yoshikawa in “The Torch of Koan, passing on the flame to the future, ” J. Orthop. Sci. 2015: 20; 237 -238

Dr. Christoph Hufeland (762 -1836): The healing art, therefore, is something sublime and really divine; for its duties coincide with the first and most sacred laws of religion and philanthropy, and require resignation and an elevation of mind far above worldly desires. None but a really moral man can be a physician in the true sense of the word, and it is only such a one that can find satisfaction in his vocation…

You must know that the idea of vocation has been a struggle for me, too. This Catholic, this orphan, this good and able child who fell far short in earning the love he desperately sought. I am learning the art of tolerance, tolerance especially for the sorrow, longing, and imperfections that have taken up permanent residence inside me. We are not the only ones who worry about a legacy. Every day I listen to patients who lament their lost dreams and the cruel twists of fate. Yet somehow we are all surviving, helped—I believe—by a mutual desire for honest conversation. This is my life’s real work, the great corpus, the body that I and so many of my colleagues offer the patient in unremarkable ways. It is, of course, our own body—just us—sitting behind closed doors with another who is equally muddled or maimed. Another who—to our joy and surprise—is able to come alive. – David Loxtercamp, MD

How can you help Mission? It cannot exist without you. • Never doubt that you are in the lead • Call us out when we threaten to accommodate our ethics to expediency • Work with Administration to try to find ways to prevent burn out and increase resiliency • Do unto others!! • Educate the next generation • Whatever you do, don’t give up on us! (patients, I mean)

Thank you! painting by Pascal Dagnan-Bouveret, 1852 -1929, Walters Art Museum, Baltimore, MD