April 2008
What it means to be a physician

Jared N. Schwartz, MD, PhD

I’ve been trying to get people thinking about what it means to be a physician—not a pathologist, specifically, but a physician. If your son or daughter were considering medical school, what would you tell them about this profession? Other than specific knowledge and skills, what attributes distinguish a physician from another health care professional?

Most of us can remember opening the letter that said we had been accepted to medical school. Physicians rarely talk about that, or about the relationship between our adult selves and the idealism that sent us down this road, but we should. Medical school is a shared baseline. And many of us have wonderful stories about mentors and role models who saw something in us that we didn’t recognize and pointed us in the right direction. Those stories should be shared. As should the advice of those who’ve given this some thought.

Fred Gorstein, MD, professor and chair of the Department of Pathology, Anatomy, and Cell Biology at Thomas Jefferson University Medical Center in Philadelphia, holds weekly clinical rounds that include in-depth discussion of professional and ethical issues as they occur in practice, thus incorporating the hands-on mentoring that is most often coincidental. Professionalism, Dr. Gorstein says, is about personal integrity and accepting appropriate responsibility. Moreover, a physician’s professionalism involves self-correction, respect for others, altruism, compassion, and cultural sensitivity. Privacy concerns are important, as is the duty to ensure truly informed consent, and finally to know and do what is right even when no one is watching.

James M. Crawford, MD, PhD, chair of the Department of Pathology at the University of Florida College of Medicine, Gainesville, and president of the Association of Pathology Chairs, says that a critical transformation should occur during residency. Appreciating the responsibility that comes with the privilege of caring for patients, and understanding the impact of our work, he says, are integral elements of professional competence. The most successful pathology residents, he says, are those who live that responsibility, holding to the highest standards of being a physician. Those who believe they are present only to provide information will struggle.

Paul Bachner, MD, professor and chair of the Department of Pathology and Laboratory Medicine at the University of Kentucky College of Medicine, Lexington, and a CAP past president, says the most important lessons of residency aren’t about skills but about attitudes. Directly or not, through didactics or example, every physician teaches. As Jackie Granese, MD, dermatopathology fellow at the University of Tennessee, observes, residents are reluctant to go out on the floors and make rounds if they haven’t seen their attendings doing the same. What our young colleagues have not seen, they are not likely to do, and compassionate interaction with patients requires specific sensitivities.

Affinity for a systems approach is also important, Dr. Bachner says, because quality patient care requires the cooperation of many professionals. Physician extenders often have more direct patient contact time than physicians, whose patient encounters are necessarily brief. This has to be discouraging and isolating for someone who chose medicine because it meant working with patients.

Part of being a physician is giving support to other physicians, and while we may not be able to change their work environments, communicating clearly and frequently with our colleagues will ease their stress. This is one reason to take a few minutes to call a fellow physician to discuss treatment options when the pathologic analysis is complete. Another reason is continuity of care. Because many patients see several specialists, the pathologist is often in a position to observe redundancies or conflicts in current treatments that specialists need to know about.

As director of the Office of Biorepositories and Biospecimen Research at the National Cancer Institute, Carolyn C. Compton, MD, PhD, is in a position to see the value of a specific type of direct patient contact—that involving a patient’s specimen. Dr. Compton’s work involves developing quality standards for managing human biospecimens and the data associated with them. Biospecimens are living, changing biologic entities capable of reacting to their environments, Dr. Compton says. The pathologist who takes custody of a specimen takes responsibility for continuity of care.

If you ask Thomas M. Wheeler, MD, chair of the CAP Council on Scientific Affairs, to define the character of a true physician, he will quote his father, who told him years ago that the physician seeks “to cure few, to help many, and to comfort all.” Time for the art of medicine is shrinking in response to the time required to implement new technologies, Dr. Wheeler says, but its importance has not diminished. The art of medicine is the comforting, Dr. Wheeler says. The science of medicine is the cure.

At the start of this column, I mentioned the stories many of us can tell about mentors who set us on the path to medical school. I’d like to close with a recollection from Gregory J. Davis, MD, professor of pathology and lab medicine and residency program director at the University of Kentucky.

Dr. Davis wasn’t thinking about medical school when he started college. He was a literature major planning to teach, and his part-time job in a local emergency room was about earning money, not learning medicine. So when the physician and on-duty nurse one night asked their 19-year-old nursing assistant to sit down for a talk, Dr. Davis thought he was in trouble. Instead, they said, “We think you should go to medical school.” At that, Dr. Davis says, he “recoiled in horror.” The best he could summon was, “Why?”

They said he had a knack for being with people. Fine, Dr. Davis said, but he couldn’t possibly be smart enough for medicine. They dismissed his worries. He would need to synthesize vast amounts of data, they said, but that was less important than what he seemed to do naturally: apply what he had learned in the human context.

Today, Dr. Davis will tell you that for him, medicine is an opportunity to use scientific knowledge and to be with people, to truly know them. Medicine, he says, is about the right way to live; it’s about building a life. That’s a physician, all right. More than 20 years ago, two good people saw that in him and took the trouble to let him know. They showed him what he knew in his bones, and he continues to pass it on.