Following a series of professionalism workshops hosted by the Royal College of Physicians' (RCP's) 'Professionalism: The dedicated doctor - what does it take?' project, Michael Trimble, consultant physician in acute medicine at the Belfast Trust, gives us his personal reflections on the importance of compassion, calling and citizenship.
In part one of his 'Professionalism' blog, Michael discusses his views on compassion and calling.
In the past year we have seen some of the most bitter disagreements between doctors and the government in living memory. How do we fit it all together? Do we have a vocation that is larger than our contractual obligations? Have we truly made a ‘profession’ for the good of the patient? Or have we signed up to deliver medical services within the terms of a business contract; where our side of the bargain is to do so efficiently and effectively but after which the terms and conditions are up for debate? For example, what should the trainee do when their working hours are being monitored, their employer is encouraging them to go home to avoid a shift over-run but they are with a sick patient and they know that the covering doctor is going to be free to attend for some time?
In trying to unpick this a bit more I have found the following framework from ethicists Glen Stassen and David Gushee helpful. They note that consideration of ethical conduct, ie doing the right thing, takes place at a number of levels:
- the circumstances of a particular situation,
- where the right course of action may be clear.
- where the right thing is not immediately or intuitively clear we may seek to apply rules.
Rules apply not just to the immediate case but to all similar cases. Rules tell us directly what to do or not to do. If there are no rules or if multiple rules are in conflict we move to our underlying principles. Principles may support rules - or criticise them. A principle is more general than a rule; it does not tell us directly what to do. Lastly, our principles will be influenced by our most basic convictions which form the foundations for all our principles, rules and overall ethical reasoning.
. However there are times when this is not enough and the rules are in conflict with each other or else the situation just seems too hard.
In the ordinary run of things we can make uncontentious decisions as we go about or job. In certain situations we are constrained by rules and in others assisted by guidelines. Following these demonstrates our professionalism. However there are times when this is not enough and the rules are in conflict with each other or else the situation just seems too hard. Then we must dig deeper and look to our principles – our profession of our commitment to the patients we serve. Hence we may at times ignore the end of the shift to look after the ill patient.
But what is there after that? There will be times when there are greater challenges, when we question even the reason for our professed commitment. What then – what causes us to say no to the temptation to ‘jack it all in and just be a normal person’? It is it this point when we need to fall back on our core convictions. For me the sense that medicine is a vocation, that it is what I am meant to be doing, has kept me going through numerous challenges, and in no small part is what gives me joy and purpose in my daily work. I think that you can practise medicine without it, even have a successful career – but to thrive it helps to have a vocation.
Michael Trimble, consultant physician in acute medicine at the Belfast Trust.