On Calibrating the Physician

Essay by Elvie Victonette Razon-Gonzalez Posted online 2:20 AM, November 19, 2017; First published in September 2017

If you know the enemy and know yourself, you need not fear the result of a hundred battles. If you know yourself but not the enemy, for every victory gained you will also suffer a defeat. If you know neither the enemy nor yourself you will succumb in every battle. Sun-Tzu’s The Art of War

Medicine and War. War and Medicine. An oxymoron when used in the same breath. Two different concepts, one almost negating the other. The delineation is quite clear. There is no mistaking it. One breathes life into man; the other snuffs life out of him. The other edifies compassion; the other nullifies it with unimaginable atrocities.

Medicine is ennobling and enabling both to the giver and the recipient; War does neither. William Westmoreland says that War is fear cloaked in courage. But Medicine is fear cloaked in care. Nevertheless, both are deemed to exist for Higher Causes such that all means, all resources are exhausted to achieve the greater foreseen end. Medicine is primarily for the preservation of individual life. War is the preservation of a certain kind of humanity. In some ways, they are almost congruent.

In Sun Tzu’s The Art of War, he speaks both of the enemy and the self as essential forces to be conquered and mastered should victory be ultimately sought in every battle. Though War is more concrete and speaks of a certain, absolute enemy, the enemy that Medicine fights against is understated, nonetheless, overwhelming.

For if one thinks long and hard, Medicine is a non-ending battle against a malevolence in humanity that wars in the past have unwittingly fought for. It is a battle for humanity. The enemy is the scourge of diseases that have plagued man since his creation and eventual fall. Each patient is a hapless victim, not of brute force, but a more lingering, debilitating and a slowly destructive element, disease and its repercussions. Each physician is thus likened to a soldier defending a cause who must use all his skills and armamentarium to win the battle. While a soldier possesses the necessary skills to survive harsh conditions and cruelties brought about by War through rigorous training: discipline, strength, endurance and courage, a Physician must also learn to possess these skills and incorporate them into his practice. Discipline by devoting much of his time learning from his books. Strength by stretching his mind, his character through the daily rigors of hospital life. Endurance through perseverance and willingness to give up some of the luxuries and joys that other people easily take for granted: time for family, time for leisure, time for sleep. Courage by taking risks in ruling in and discarding possible diseases inflicting the patient, courage by standing up for a diagnosis once everything has been considered, despite the slim possibility of being right and the nagging, no matter how infinitesimal, chance of making a detrimental mistake. Medicine and War both involve lives. One wrong move, even the slightest train of thought, has the power to change the course of events for the patient.

As such, as Sun-Tzu has wisely admonished, one cannot undermine the importance of taking into consideration every element in a battle: knowing yourself (insight or self-awareness) and knowing the enemy (foresight).

For physicians, being aware of oneself includes knowing the beliefs he has always held and grasped, knowing the motivations and possible rationalizations for his actions and decisions, knowing his weaknesses and his strengths, and more importantly, how these elements have helped shaped the character that he brings in dealing with decisions and ultimately in patients themselves.

Perfecting physician personal awareness or the “insight into how one’s life experiences and emotional makeup affect one’s interactions with patients, families and other professionals,” equips him with the armor to make better judgments without personal prejudices. This is to help patients attain better health care.

On the other hand, all men, including physicians are warriors. They are mere mortals who must at some point succumb to failure, losses, grief, the brutality of being human. For physicians, it is oftentimes difficult because of the perceived notion of always being infallible, of being all-knowing that lapses in understanding, trivial mistakes could have a profound effect on his ego. This could lead to personal destruction and if uncontained, could even be projected to his patients. The physician also runs the risk of getting burned-out or experiencing the classic compassion fatigue wherein he has lost his personal driving forces.

It is thus very important, as the journal Calibrating the Physician: Personal Awareness and Effective Patient Care by Dennis Novack, MD, et al. suggests, to take concrete and positive steps in increasing one’s personal awareness and in consequence, increasing the effectiveness in patient care; that is, identifying one’s beliefs and attitudes: core beliefs/personal philosophy, family of origin influences, gender issues, socio-cultural influences, identifying one’s feelings and emotional responses in patient care: love, care, attraction and boundary setting in medical care, conflict, anger, coping with challenging clinical situations and physician self-care. The latter involves balancing personal and professional life, preventing and managing stress/burnout/impairment and even joining support groups for positive reinforcement.

For what is even more intimidating is the fact that more than soldiers in battles, more than warriors in bloodshed, physicians are oftentimes perceived as gods: their words alone possess the power to bring joy and grief, their decisions could be detrimental or instrumental. A cloak of greatness hangs about him. And sometimes, he forgets. He forgets that like the rest, he is not the supreme God who reigns over everything and everyone, including him.

Dr. Elvie Victonette Razon-Gonzalez is a gastroenterologist practicing in Iloilo City. She is a mother of three, married to Dr. John Paul Gonzalez, a colorectal surgeon. She is an art enthusiast, voracious reader, leisure biker and shabby chic/ modern vintage lover.

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