"Wait...What??!!" moments - Part 7

Professional Identity. It’s best to speak in positive terms but I’ll start this definition of professional identity from the breach. When you finish this, please drop me an email to disagree, challenge, amplify. Your comments will generate a future post.

Please take a look at this 1-minute youtube video of Marcus Welby, MD. https://www.youtube.com/watch?v=SJBg6EYrXGs then let’s talk.

This popular (1960s) television doctor expected patients to come to him on his terms. He expected them to follow orders or risk his contempt. He freely shared his judgment, sure that it was good medicine. When his patient asked a question, impatient, he got louder.

If you asked him to describe a physician exemplar, his answer might be that the state of medical knowledge - alone - was the measure of the doctor. Today, we value patient autonomy, shared decision making, the therapeutic relationship, knowing the issues and motivations of our patient, and knowing that it is what is in them that gives them the power to make favorable (but challenging) changes.

So, what is our ideal professional identity? The answer is a series of questions: who am I and who do I aim to be? What qualities in myself do I prize and what qualities would I like to develop or refine in order to be satisfied with my journey as a physician? Who we want to be influences how we interact. Reflection and practice are how we get there.

Step one is to accurately identify one’s own inner frame of reference, one’s moral center. I say “accurately” because humans can be hyper-self-critical or insufficiently self-critical. I say “moral center” because ours is a moral profession, grounded in the outward concern forthe well-being of others. Intelligence, optimism/pessimism, insight, bias. Our depth of understanding of the characteristics that have helped or hindered us, who we are, is the start.

Our core personal identity is seasoned by society’s expectations of us as physicians (e.g., competence, respect for patient autonomy, honesty,) society’s hopes (e.g., empathy, patience, kindness,) and what we have absorbed - often unconsciously - as we have risen step-by-responsible step within medical culture.

As students, knocking on the door, to trainees, seeking competence, through to full membership in the profession, we have had sentinel experiences. Our first dissection in the anatomy laboratory, our first patient death, the exceedingly brilliant and empathic attending who we would want to be like, and the attending who publicly mistreated students or trainees, all of these shaped us, helped delineate the “Who am I” question. Reflecting on them in light of who we aim to be is decisive of how we act. Our professionalism arises from our identity.

“Have I accorded this individual’s gift of his body appropriate reverence? “How did I bear witness with this dying patient and her family? “What made that attending so knowledgeable and so kind? What drove this attending to speak that way? Was the act tailored to achieve the goal? Do I want to emulate that conduct?”

Questions of professional (and, really, personal) identity occur to us in the moment but, with greater clarity, we ask these questions of ourselves over the years. We use these questions to actively shape our personae, our personal and professional identity and the environment in which we act. In that way, we assure that we succeed by our own high standards. What follows from knowing ourselves and, increasingly acting more and more in line with revealed values is a deeper capacity to hear our patients and to be better physicians, colleagues, and friends.