Community Post - The Checkup

We reached out to 5 renowned doctors from different specialties and asked them to share their Views on ” What it means to be Noble in the Medical Profession”

Do let us know your thoughts in the comments section below.

Medicine is said to be inherently a noble profession as it has qualities such as empathy, putting the patient first above everything, respecting the confidentiality of a patient etc. Just because I am a doctor it does not necessarily imply that I am noble. That does not absolve me of my own responsibilities towards the profession.

On the contrary, if at all. A doctor imparts noble qualities to the medical profession and imbibes the inherent nobility of the profession. It is the mutual give and take between a profession and a professional that makes nobility of the profession stand out and shine. The nobility of the profession is always available to a doctor.

It is the doctor who needs to be available to the nobility of the profession. I, as a doctor, need to stop thinking of myself as God even if a patient happens to call me so. Instead, I need to be simply as human as possible- experiencing all human emotions, enjoying my success while at the same time admitting my ignorance or failure to myself if that is the case. I need to practise and experience empathy and compassion towards my patients, letting go of money and personal pleasures at times in the interest of a patient and going the extra mile to help a patient.

If I am able to feel grateful and joyful when I gather these experiences, I am available to the nobility which is inherently part of the profession. Nobility is not in the eyes of others. It is in the eyes of oneself; it is a quality one relates with, inside oneself.

When I grew up in the 1960s, especially with my father being a doctor, it certainly felt that being a medical professional is a very noble thing to do. With the kind of respect, trust, and admiration he received in the community, it certainly motivated me to be a doctor.

As I realized the need to specialize to help the patients better, I became a neurosurgeon. The struggles in training etc. can be compared with famous stories of train travelling by many cricket celebrities and some the failures seen in early life with the early stories of famous actors. However, the immediate gratification derived from successful treatment/ surgery of a difficult case was immense and enough compensation.

This propelled you to treat more difficult and needy cases without any other (material) consideration and made it a noble cause indeed. This word has not remained trendy anymore because of the rising cost of medical education as well as medical and surgical treatment.

The addition of medicine to the category of “business” with patients being labelled as consumers has further eroded the mutual trust.

Corporatization of medical business has brought us to a stage where the word used for the medical profession: “Noble” has become embarrassing to use generally.

However, I still consider that to reduce suffering of fellow human beings is an important and a noble aspect of our work and many of us are still devoted to this pursuit and will continue to keep it relevant.

What it means to be noble in the medical profession

Of all the professions, I feel that the medical profession is the most noble. It is the only profession which helps a person from birth till death, trying to decrease pain, alleviate suffering and many times, heal. Maybe altruistic philanthropy comes a close second.

There are seven primary ethical principles of healthcare. Out of these, one has gained pre-eminence, in my view – Non maleficence, or the principle of Do no harm.

Let me give a couple of examples.

If I follow theory and protocols in a non- affording patient and make him spend on investigations, especially when my clinical judgment tells me that they are not going to contribute to patient management, I am doing him harm, financially, if not medically.

If I do not provide end of life care, especially to old and moribund patients, if I do not hand hold the patient and the family through this difficult time, if I do not decrease their guilt and grief while refusing aggressive treatment in end stage diseases, I am doing harm.

As we age and mature, become more measured and deliberate in our way of medical practice, our definition of nobility and what it encompasses, changes.

What it means to be noble in the medical profession

Medicine is a biological but also a philosophical exercise. Science helps to treat the body but the art of medical practice treats the mind and soul. One without the other falls short of the desired outcome. It is the mind that contributes to healing. The patient is not an inanimate object that can be managed by technology. The patient does not care how much you know but wants to know how much you care. A patient expects holistic care and needs time and conversation with the doctor, besides relief from suffering. To offer what is expected by the patient itself means to be noble in the medical profession.

Holistic care is possible with human qualities that are endowed by nature to all of us which include the use of body (knowledge), heart (compassion), mind (commitment) and soul (inner conscience). When holistic care is delivered with devotion – selfless dedication, it results in divine healing.

There are several attributes to being noble. A doctor must follow ethics. Four pillars of ethics include beneficence, non-maleficence, justice and privacy. Besides ethics, other attributes include humility, empathy, compassion, patience, courteous behaviour, communication, counselling, documentation, time management, skilled planning and “high-touch” (not high-tech) human connection to foster a doctor-patient relationship. Noble behaviour is a measure of honesty, transparency, accountability and responsibility that instils trust, faith and respect in a patient and improves compliance. It also boosts confidence and happiness in a doctor.

Much before science developed, patients had faith and respect for doctors because of their noble behaviour. However, despite fast-advancing science, dehumanizationof medical practice has maligned the image of the profession resulting in mistrust and deteriorating doctor-patient relationship with its consequences of arguments and violence.

Can we reverse this trend?

Patient listening to what the patient wants to say is the first step toward empathy. Further, history-taking sets the tone for communication. Physical examination with appropriate touch results in emotional bonding. Counselling denotes compassion – to know what the patient feels and try to comfort him. We need intrinsic motivation driven by the enjoyment of work – pleasure without expecting a reward and it should come from within. Motivation determines what you do, attitude decides how well you do. It is the attitude that takes you to altitude. The motto in medical practice should be “care always, cure if possible”.

What is nobility in Medical Profession

I have often wondered why only medical profession is labelled as Noble.

I get reminded of a story from our folklore that describes a young man who aspires to be a Maharshi and leaves his parents and home to do penance in Himalayas. He does intense penance and acquires superior powers. Happy with the powers that he has acquired, he descends into the plains and seeks food from the first house that he sees. The lady of the house was busy looking after the needs of the family and asks the boy to wait for a short while. Enraged by the lack of proper attention, he curses her, BUT to no effect. The boy realizes that she had more powers than him and asks her for the secret. She says that she is too busy and advises him to go to the cobbler at the end of the street for explanation. A bit mortified, he nevertheless goes to the cobbler. The latter was busy working and had a target to respect and so asks the boy to wait a bit or go to the butcher in the next street. Now half aware of the truth, he goes to the butcher who asks him to wait for a few seconds while he completes an order. He then takes the boy to the butcher’s house where he tends to his family and parents. The boy then realized two things. 1. That every profession is quite noble if properly done and 2. His first responsibility must be towards his parents who were getting old.

Then Why is Medical Profession alone described as NOBLE. Enlightenment came to me when I was working in Pediatric Surgery in Medical College, Calicut. On surgery days, the mothers take the babies to the ante-room where the babies are sedated. Our surgery attendant goes to the room and brings the baby to the operation theatre. On many occasions when I am relatively free, I do that job myself because, rightly or wrongly I believed that such a gesture made the mothers calm. When I take the baby from the mother, I take a look at the mother’s face to analyze the emotion on her part, when she sees her dearest possession being taken in for surgery. Was it fear that something may happen? Was it anxiety? Was it anger and frustration that such a situation befell her? But I was firmly convinced that the predominant emotion was one of Trust. Her trust in me that I will do the right thing to her child and bring relief to her most precious possession. I realized that the trust that the patient or his mother or relative placed on the doctor is what made medical practice noble. One might argue that the airplane pilot or the bus driver also holds the life of his passengers in him but their profession is not scribed as noble. The answer is that the one to one trust between patient (mother as the case may be) and the doctor is a bond that makes the profession noble.

BREAK THAT BOND AND THE PROFESSION CEASES TO BE NOBLE. Do not let any other factor (such as money) take its place.