Tuesday, July 3, 2018

Transmission of Values within a Profession

Last night I had the pleasure and privilege of having an extended conversation about medical ethics with Laurie Patton, president of Middlebury College. I was surprised when Laurie expressed great interest in my experience teaching medical ethics. Was she just being polite? It turned out to be much more than that.

Laurie explained that two months ago she’d invoked the Hippocratic oath and the influence of her surgeon father in an essay titled “Our Moral Directive,” in which she argued that “a Middlebury education should be accessible to all, regardless of financial means.” Here’s the opening paragraph:

My father is a retired cardiovascular thoracic surgeon. My childhood memories are punctuated with instances of him being called away from home for emergency surgeries. On those days, and many others over his long career, he never questioned whether the patients whose lives he was trying to save were able to pay for his services. He had taken the [Hippocratic] oath to heal to the best of his ability all those who presented themselves—and he spent his career doing so…In higher education, we don’t—yet—have our own official version of the Hippocratic oath. But at Middlebury, we do have a mission that serves as our moral directive… 

Our conversation and her essay conveyed a crucial insight into what it means to be part of a profession. As professionals we profess values imbibed from our teachers. Laurie invokes two - her father and Hippocrates. She treasures stories her father told about nurses in the operating room who saved him from making mistakes. From those stories she took lessons about respect for competent women, humility about one’s own expertise, and teamwork to serve patients.

Out of curiosity I Googled “Dr Patton cardiovascular surgeon.” What I found reinforced the lesson about transmission of values within a profession. In college Dr. Patton broke his collar bone playing hockey. Two of his moral influences were the surgeons who took care of him – their empathy, competence, positive attitude and the pleasure they took in their work. And in an essay of his own, Dr. Patton tells the story of Dr. Daniel Fiske Jones, a noted surgeon who graduated from Harvard Medical School 62 years before Dr. Patton did. The subtext of the story is that Dr. Patton is guided by the same values that guided Dr. Jones.

In my first year of medical school I experienced the process of value transmission directly. I was in a tutorial group that met with Dr. William Castle, a distinguished hematologist. Dr. Castle, who was 63 at the time, described the following dialogue from when he interned at the Massachusetts General Hospital in the early 1920s:
Teacher: Dr. Castle, if you had a patient with pneumonia, and you did ABCD, but the patient died, how would you feel?
Dr. Castle: I would feel terrible!
Teacher: Dr. Castle - if you persist in feeling that way, you will have to leave medicine. You would have done everything that we are able to do at this time. You will have to learn to govern your emotions! (reconstructed from my memory)

Dr. Castle was a gentle, compassionate man who I admired. Over the years his story has led me to reflect on the challenge of how to be close enough to our patients to feel love for them, and at the same time to have enough internal "insulation" to maintain our own stability when our patients do not do well.

Laurie Patton is applying the values professed by her surgeon father. I reflect with my own students about the values Dr. Castle's teachers tried to pass on to him almost 100 years ago. 

That's a large element of what professions are all about!

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