Definitions
- An act of the will to the effect that the physician surrenders himself readily to the service of the patient
What is Devotion?
- An act of the will, not a feeling.
- Devotion is a surrendering of the self, which involves effacing self-interest and preferring the good of the other.
- Service of the patient: the good of the patient involves not just their medical good, but their material, emotional, and spiritual good.
- “Love both causes devotion and feeds on devotion.” (Aquinas)
- The devoted physician sees the good of the patient as higher than his own interests, and therefore wholeheartedly surrenders himself.
- If love is what prompts devotion, you must foster a relationship with the patient.
Why should we practice the virtue of Devotion?
- Beneficence is necessary for the profession of medicine, and devotion is a perfection of beneficence.
- Without devotion, our patients become simply subjects or customers.
- Devotion is necessary for being able to treat the patient as a whole person, not merely medically.
- Devotion and relationship result in more peace and satisfaction for the physician, and is an antidote to burnout.
- Devotion leads to joy: if you truly believe that your self-surrender is in service of a great good, you will indeed throw yourself into this service with joy, despite the sacrifices.
Aristotle’s Doctrine of the Mean
Aristotle’s Doctrine of the Mean emphasizes balance as the essence of virtue, symbolized here by a mountain peak with a flag representing the ideal midpoint. Each virtue lies between two opposing vices—deficiency depicted on the left, and excess, on the right slope. For example, courage is the balance between cowardice (deficiency) and recklessness (excess). In a medical context, this principle guides healthcare professionals to strive for the peak of ethical behavior, avoiding the pitfalls of extremes to ensure thoughtful and compassionate care.
Case Studies
You are a medical student shadowing a senior family medicine resident in clinic. The resident is seeing at least twenty patients a day, sometimes up to 12 per half day, and you do your best to keep up and see patients alongside of her. You’ve observed several instances in which the patient seems to have more going on than the resident can adequately address in the time-allotted in her clinic schedule. Just yesterday a patient asked a question while the resident had her hand on the doorknob, ready to leave the room.The resident interrupted her tactfully and asked her to make another appointment, apologizing that she doesn’t have the time she wishes she had.
You decide to ask the senior resident about this. She is typing in the electronic health record, pauses, and says: “You just have to do what you can in the slots you’re given. You could invite the patient back for a longer appointment like I did, but probably not every time—and honestly I’ve tried that a lot and they don’t always come back. Sometimes I’m just trying to get the metrics in so insurance will cover what the patients need. That often takes priority. And at some point I have to get home. I can’t give every patient the extra 15 minutes they might need. I gave up trying to cultivate a relationship with my patients a long time ago. I’ll try again once I’m out of residency and have more control over my schedule. There’s just no time right now.”
Discussion Questions
- How can you be devoted to your patients when you are too pressed for time?
- In the first clinical case, is the resident right to cut short her meetings with patients? Why or why not?
- Can you be devoted to your patients without cultivating relationships with them?
You are a primary care clinician in an outpatient clinical setting. Ms. Davidson is a 78 year old widow who you established care with 6 months ago. Since that visit, she has visited you every two weeks, each time with a long list of complaints that usually have no actionable endpoint or even clinical importance. You’ve been praised before on your patience and listening, but today you’re behind, and Ms. Davidson senses your frustration. She says “I know I’m a handful. I just don’t have anyone, and I get anxious. Other doctors have told me they need to set boundaries with me, but I’m not stupid. That usually means I just end up talking to random clinical staff because they don’t want to talk to me. I’m just looking for a doctor who will stick with me even with all my questions. Are you that kind of doctor?”
Discussion Questions
- Should we still be devoted to patients who just seem bothersome and don’t seem to require actual medical help from us?
- How can we foster devotion to and relationships with patients who test our patience?
- Is it the place of the physician to have a personal relationship with his/her patients, or would that compromise the professional relationship between them?
How do we foster Devotion?
- To foster a relationship, get to know the patient.
- Love both causes and feeds on devotion: if you love the patient, you will become devoted to them, which will in turn cause your love to grow.