I was asked to give a brief presentation at an event celebrating faculty appointments and promotions at the hospital. What follows is the transcript of my remarks.
I have been tasked today to discuss the question, "What does it mean to me to be an academic physician?"
Medicine is a noble profession. The art and science of healing has long and rich tradition that has been passed from Hippocrates to each successive generation of physicians. Perhaps one of my favorite icons of medicine is a Victorian era painting by Sir Luke Fildes entitled "The Doctor." The image depicts a child of humble means in the pre-dawn morning, laying ill across a makeshift table, his parents in the shadows expressing grief over the gravity of their son's illness. In the foreground a nearby gas lamp illuminates a physician as he sits staring at the boy, carefully contemplating his illness. To me, this image represents the professional devotion that we have for our patients.
Though clouded by the obliging complexities of our modern healthcare environment, when the exam room door closes and all is stripped away but the doctor and the patient, the true nature of what it means to be a physician is still seen. It is a place where the patients share the most intimate parts of their lives and bodies so that we can bring them healing or alleviation of their suffering.
There are many aspects describing what it means to be a physician. William Osler argued that one of the first duties of a physician was to educate the masses. Galen argued that a physician ought also be a philosopher. In a less august forum (twitter), I made the argument that a physician is an intersection between a scholar, healer, and advocate.
Much has changed in the practice of medicine since the time of Osler and Galen. Just the last 100 years have given us amazing new understanding about the science of the human body and incredible innovations allowing us to push the boundaries of human longevity and flourishing. Throughout history these great movements and advances in medical care and medical science happen on the benches or in the wards of our academic medical institutions.
Early in my career, one of my mentors, Dr. David Bahner, described to me four pillars of academic medicine - a paradigm that has helped me categorize what it means to do the work of an academic physician.
The colonnade begins with the clinical care of patients - the sine qua non of being a physician. For us doctors in this room today and throughout this hospital, we are first and foremost clinicians. We care for patients, make diagnoses, and intervene to prevent or mitigate the effects of disease.
I practice here as an emergency medicine physician. Our specialty stands as a beacon of hope to our community where are doors are always open and our lights are always on. We are trained to quickly manage the airway of a patient in respiratory distress; treat the young man suffering from the effects of his heroin addiction; and comfort a grieving mother moments after terminating the resuscitation of her young son who's precious live was prematurely cut short. My ED colleagues and I are proud to stand as that symbol of hope for anybody who presents regardless of their complaint, the time of day, their station in life, culture, creed, or ability to pay.
The second pillar is the Administration of programs. As physicians, we have a unique ability to seek, interpret, synthesize, and decisively use data. This skill lends itself well to being a leader in the administration of medicine. In my current role, I serve as the director of the ultrasound division in the Emergency Department. Our group facilitates and oversees the use of ultrasound by physicians at the bedside in order to better assess and manage patients.
The third pillar is the Research of new knowledge. Academic medicine is a life of discovery. It is a quest to find answers to previously unanswered clinical questions. It is a search to find the new test, new medication, new therapy, or new procedure that will improve patient care. Today. we practice on the shoulders of those physicians and scientists who, in years gone by, have devoted themselves to bench and clinical research.
This leads us to the 4th pillar: Education of new learners. Medical trainees are the life blood of academic medicine and are the next generation of physicians and leaders. This has been the primary focus of my academic career. In our division, we train medical students, residents, and fellows and faculty in our department, across the hospital system, and out in the broader healthcare community how to perform and interpret bedside ultrasound.
One of my specific responsibilities is to run a weekly, multi-departmental Ultrasound Grand Rounds where we typically discuss unique, advanced, or nuanced ultrasound topics. When COVID forced us apart, we began recording our lectures and started a YouTube channel to share the educational material that we have been producing here at MetroHealth. This forum has been an amazing opportunity not just for me but also serves as a platform whereby I can help promote and share the amazing material of all of my ultrasound colleagues. Our YouTube channel now has generated over 130,000 views and is watched and shared by people around the world.
As we step back and think about these pillars, it is important to note that this list describes what it means to do academic medicine. But as we discuss the question, "What does it mean to be an academic physician,” there is one important element that so far has been missing from our discussion.
As anybody knows, the most vital part of a house is its foundation. Without a firm foundation, no matter how well built, a house without solid footings will crack and crumble. In a similar way, the pillars supporting the house of medicine need a firm and solid foundation lest they merely become things to fill out a CV or hubristic accolades that we accumulate for our own self-glorification. To keep our sights on true north, we need an ethos that undergirds our activities and provides the basis for the nobility of our profession. For this foundational ethos, we turn to the ancient Greeks.
The Greeks had a term, arete, that is typically translated into English as excellence. But to the Greeks, it meant so much more than just achieving the superlative. To them it referred to the highest quality of a thing. It represented the pursuit of virtue and the fulfillment of one's purpose. This Greek term was used by Homer to describe Odysseus and Achilles. It was pondered in the philosophical works of Plato and Aristotle. And it was used in the biblical text by Paul to prescribe our ideal life and conduct. To the Greeks, Arete was an ethos. It transcended the mundane in pursuit of a divinely inspired ideal.
Recently, I have been particularly interested in the idea of arete, exploring its application to both life and to medicine. This journey was born in the shadows of burnout and boredom as a desire to find meaning and fulfill my purpose in medicine. It has led me to starting the Excellent Physician Project and blog.
On this forum I explore how to find balance between our personal and professional obligations and how areteshould be an encapsulation of what we seek to achieve in medicine and in our own lives. Applied to my wife, arete means pursuing her with single-minded devotion. To my children, it means engaging intentionally and meaningfully with them to train them to think rightly and to achieve their highest potential. As an individual, it means doing things that build and cultivate the body and the mind and the spirit.
Applying arete to medicine, as an academic physician it is a quest to provide the highest quality of care to my patients, to break new boundaries of knowledge, to define and improve the systems of care, and to train and mentor the next generation of physicians to live and practice in the tradition of Hippocrates, Galen, Lannec, Flemming, and Osler. As a physician, arete is a calling and challenge, not to be driven merely by money or by metrics, but to pursue the highest ideals of medicine. And in that pursuit, to be a reflection of the divine.
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