EI)1TUR1

L

The

Ideal

Physician

IN A RECENT

in the Journal

COMMENTARY

mond (I) highlighted the desirability qualified medical students possessing accepted characteristic ofthe ideal

ofthe

proposed that historically and practically, skill, knowledge, and humanistic attitudes except

for a “very

The

ideal

then

has

physician

cine (3). What ing the qualities can

one

Medical

Association,

achieving a consistent (the ideal physician?)

Di-

scientifically generally Pellegnino (2)

triad ofexcellence in is perhaps unlikely

few persons.”

physician

a humanist

American

as well as the difficulty in selecting the personal quality of compassion-a physician. In anothenfAMA article,

been

(2),

and

described as one

as a compassionate

who

practices

is meant by “compassionate,” ofan ideal physician? Ifone proceed

grams for him? There seems

to select

to be little

such

debate

“humanist,” cannot define

a person

about

“the

what

medical art

and

scientist

the science”

(I),

as

of mcdi-

or “art” when one is definthese specific qualities, how

or develop

enhancing

a scientific

physician

educational

pro-

is: he or she

must

base his/her professional skills and practice on the foundations of scientific discovery, on information and techniques acquired by employing the scientific method (and tolcrated amounts of logical, deductive reasoning). But when you ask six people to define a compassionate on humanist physician, the usual responses consist ofa variety of six commonly agreed upon examples: rarely do they provide a useful or clear definition. Any effort to deflocculate these muddy waters should identify some basic personality characteristics sured, or at least “ideal” physicians fective, sions with

and

peripheral

and scientific the potential

Underlying quate base cian, these empathic Lion of

of the ideal physician that can be teased out evaluated. One possibility is that compassionate, are those who are aware of and concerned with consequences activities. cognitive

this is the of scientific skills must

either

directly,

Similarly, impact on

indispensable knowledge be practiced

attitude toward those indispensable

engendered by the energies (anger, love, responses effectively the patient’s anxiety

to their

patients

or

assumption that the physician and skill. But if he is to function within a humanistic framework

patient concerns, an attitude that scientific accouterments. Aware

or indirectly,

by deed,

its potential.

In this section the Editor expressed herein are not construed

as marking

meaor af-

cognitive

dcci-

concerned responses.

possesses an adeas an ideal physithat implies an

permeates of their

the applicaown emotions

patient-physician interaction, such professionals utilize their etc.) for their patient’s welfare, not their own, or neutralize these in the patient’s interest. They foresee and sensitively anticipate about his ailment and have the ability to share this awareness

by word,

humanism,

the

primary

perhaps humanist, secondary,

such physicians are aware of and the patient of their own affective

in a way

fears with legitimate confidence in the physician. A recent student-teacher clinic provided a simple student

of their

and

samples necessarily

the official

A child

poller

tends

example

neurologist

varied opinions those of the

that

for

and

to replace evaluating

I (a child

on topical problems. Editor, nor can they

patient medical

psychiatrist)

The opinions in any way be

of the Journal.

Am

J Psychiatry

132:3,

March

1975

281

EDITORIAl.

were

teaching

As each

four

medical

of the students

students

the

examined

lines across her palms, demonstrated Ian hypotonia, one of the students washed our hands before examining and massive application over the nearly naked ondany to the primary .

cepts

,

my

this

His

precaution

crate

that

scientist. also

compassion

this

features

her

the laxness spoke up the child’?”

student

had

with

speaking

comfort

indicated and

diagnostic and

that

even

the

he believed

reward

it (he

folds,

noted

her muscuwe have the sudden

holding, flexing, and rubbing for a possible consequence seeitself. It was a clue, if one ac-

potential

for

becoming

up about

the

faculty’s

a compassionate

failure

in an environment

praised

child. the simian

ofherjoint ligaments and spontaneously: “Shouldn’t He was concerned about

he was

was

of a mongoloid

epicanthal

of bacteria, etc., by 12 hands baby. His sensitive concern was cognitive examination activity

hypothesis,

medical

key

the child

for

his

alert

to suggest

that

and

could

tol-

appropriate

sen-

sitivity).

This scope,

example is from the same cloth as that ofthe takes the time to explain in advance unfamiliar

examination, or tells a patient comfortably allows it to happen. Both in actual teaching-learning

that

such

encouraged,

qualities

can

crying

with

situations

be observed,

physician who warms sensations to expect

relief and

is a beautiful

thing

in simulated

perhaps

taught,

the stethoduring an -and

then

educational

and

certainly

clinics rewarded.

Identification of the personality traits I have described could represent one predictive step across the quicksands of identif’ving compassionate science students for medical school admission. An educated awareness of and concern for the affective component of the patient’s being

tempers

and

decisions

ofthe

they

give

advice

give

the

guides

ideal

patient

the

empathic

physician.

and

not

the

privilege

yet calculated,

Physicians

orders

to the of

are

patient.

accepting

the objective,

advisors,

not

They or

give

this

rejecting

and

dictators,

it

the cognitive

in the

advice

sense

as freely

without

that

as they

retribution.

They

possess the ability to share in the patient’s helpless on seemingly hopeless plight while remaining effective in their proper attitudinal attire of knowledgeable hope. The one common personality thread found in the fiber ofan ideal physician may be this educated sensitivity. this sympathic resonance with the patient, which does not affeet the physician’s objective ncr of rendering his decisions If this

‘-awareness

attribute

decision making or recommendations. and

sequence of cognitive, scientific major characteristic of the ideal

concern

decisions physician,

as much

as it affects

with

affective

the

and activities a better chance

-

his style and

and

secondary

reasonably describes exists for identifying

manconone such

a person when he or she applies to medical school. There is also a better chance for teaching and practicing such concern after the medical school experience. The goal of becoming an ideal physician may never be completely attained, but it would seem less courageous to forfeit an unnun race than it would be to lose it after a sincere

effort.

Without

cian and a continuous more than tradesmen,

clear

recognition

of the discernible

qualities

effort to achieve them, tomorrow’s physicians unwitting traitors to a great profession and

of the ideal

physi-

may become little a viable tradition.

REFERENCES I. 2. 3.

Dimond EG: The physician Pellegrino ED: Educating 1294. 1974 Davis R: Teaching physical

and the quality the humanist diagnosis

oflife. physician:

emotions

JAMA 228:1 an ancient and

privileges.

1 17-1 ideal JAMA

I 19, 1974 reconsidered. 226: 1 1 14

RICHARD

Dr. School.

282

AmJ

P.s,t’chiatrt’

132:3,

March

Davi.s

i.s Associate .Vor/hlk.

1975

Va.

Dean

and

Pro frssor

of

P.st’chiatri’,

Eastern

JAMA

227:1288-

I 1 15. 1973

E.

DAVIS,

Virginia

M.D.

Medical