The Yale Journal for Humanities in Medicine

The Moral Physician

Christopher Morren, M.D.

Dr. Morren has been a general internist in New London, Conn. for the past 18 years. What follows is his talk to the young people of the Westerly (RI) Friends Meeting on how the work of a physician gives witness to his or her moral character. I thought his ideas deserved a wider audience and urged him to let us publish it here. I am delighted that he did.

  Our Society looks to physicians for guidance. Physicians have this respect bestowed upon them as a group. An individual physician doesn't earn it, but obtains it by virtue of his or her role in society. Society then allows the physician to enter personal spaces ordinarily forbidden to even the most intimate friends or partners. It is by virtue of thousands of years of contact between healers and patients that this privileged relationship has developed. There is trust implicit in the relationship. It is said that this relationship hearkens back to Hippocrates, the ancient Greek Physician, who said;" I will follow that system of regimen which, according to my ability and judgment, I consider to be for the benefit of my patient, and abstain from activities deleterious and mischievous."

  Emanating from this trust has evolved an aura of the role of the individual member of this unique and learned profession: the ideal of the totally dedicated physician, selfless, always keeping the best interests of his or her patient foremost, available seven days a week, twenty four hours a day, three hundred and sixty-five days per year, willing to accept whatever the patient can afford in return for services, knowledgeable, scientific, humane, compassionate, and able to deal, without apparent difficulty, with life-threatening situations, lethal contagion, anger, hostility, threat of physical violence, and with death and dying, and still to be able to run an efficient, successful business, a safe and clean office, and keep his or her employees satisfied, happy, polite and cooperative to patients and with each other. This does not even take into consideration such recent developments as dealing with HMOs or the Federal Government.

  Physicians, in describing their own attributes tend to focus on a "calling" from which the members of the profession cannot separate their lives. This means that you are a physician all day and all night. The call means that the concern of one's patients takes priority over all other concerns including non-emergent family needs. This self expectation is one shared by our society. Society expects this level of commitment from no other profession. In return society has paid physicians as a group more esteem and respect than any other professional group.

  For Quakers the " calling" is a simple extension of their beliefs. If any biblical quote characterizes the creed of the physician it is this: "..they who wait upon the Lord shall renew their strength; they shall mount up with wings as eagles; they shall run and not be weary; and they shall walk and not faint." [Isaiah 40:31] This is , in fact, the same mission that George Fox, the founder of the society of Friends, envisioned for its members. An example of such an individual was Joseph Lister. He was a nineteenth century Scotsman and Quaker who revolutionized the practice of surgery by introducing sterile technique. In the mid-nineteenth century there remained great controversy as to the origin of post-operative wound infections Using the principles of his contemporary Louis Pasteur and his own scientific discoveries with the microscope Lister demonstrated the basis of wound infection to be the bacteria that contaminated the operating field. Not only that, but he developed an effective, although cumbersome, way of maintaining a sterile field. Despite his outstanding results the world remained skeptical, and Lister had to face the contempt and derision of his fellow surgeons for decades. It was his firm and uncompromising belief that what he was doing was right that made it impossible for him to give up.

  A physician with whom all of you are familiar is Albert  Schweitzer. As a young student of music and theology in Germany in the  late nineteenth century he was touched by his perception of human needs  particularly among the poor and disadvantaged. He also became fascinated  with Africa. He had a vision that he could best serve humanity my practicing medicine there. In his autobiography he says," One day I opened a magazine.  My eye caught the title of an article, 'The needs of the Congo Mission'. The writer  expressed his hope that his appeal would bring some of those on whom the  Master's eyes already rested, to a decision to offer themselves for this urgent work. Having finished the article I quietly began my work. My search was over. The result was that I vowed to realize my plan of direct human service in Equatorial Africa." He was thirty years old at that time. The major portion of his life's work was spent in this endeavor, even through World War I in which, as a German working in a French colonial territory, he was taken prisoner-of-war.

  My close friend and fellow physician Edward McDermott of Groton realized that if the Electric Boat Company succeeded in building a waste incinerator on the Thames River the people of this area would suffer from exposure to increased levels of pollutants in the atmosphere. He worked side by side with his wife for two years to prevent this from happening, and ultimately he prevailed.

  What is the point of these histories? As members of society we are all faced, from time to time , with situations which require difficult decisions to be made. As a rule we decide issues in favor of our self interest, and nobody questions that. Society has different expectations of physicians, and rightly so. No other group is asked to accept such a high level of responsibility for the lives of others.

  For myself the role of physician is awesome and often overwhelming. The physical demands are enormous - 60 or more hours per week plus nights on call where sleep is frequently interrupted. The expectations of patients and families are often unrealistic. Particularly as our society ages peoples expectations are to be able to live long lives and to have a very high quality of life. This is particularly true of people of my generation with regard to their aged parents. In this era of consumerism in which every product must be perfect people's ability to deal with less than optimal outcomes is also very limited. Paradoxically my generation, the most pampered in the history of the human race, is angry. They often treat me with hostility and suspicion. Sometimes they even threaten to sue me.

  It seems that, as a loved one comes closer to death , many families become more and more dysfunctional. It is then the role of the physician to bring the family together. Sometimes I feel like priest and psychiatrist, as well as medical expert as I lay out end of life scenarios to anxious family members. 

  I must add that , on top of the arduous job of taking care of patients are the meddling and insulting activities of insurance companies, the federal government and HMOs. To do our very best, as most physicians do, and to be implicitly suspected of fraud and abuse is perhaps the crowning insult of our era to the medical profession.

  So why do I continue to practice medicine? I guess it goes back to the original calling described by Schweitzer and Lister that all of us hear. For me the thrill of a successful outcome, the genuine gratitude expressed, the letter of thanks from a patient or a family member, these are the things that keep me in practice. 

  People seem to think that doctors make a lot of money. Some make a lot of money, but most don't. There are many jobs in which the hourly pay is higher than that of physicians in individuals with comparable years of education and levels of responsibility. The one who goes into medicine to make a lot of money is a fool. 

  I have tried to think of a few characteristics that help me get through my career , and I will ask you to reflect on each of these as I list them: altruism, humility, integrity, compassion, courage, commitment, sacrifice, service above and beyond self interest, stamina, charity, faith.

  Faith is listed last but is not by any means the least of these. Faith in God, in a divine omnipresence who responds to the pleas of his humble servants and gives me strength to continue my work into the long hours of night. I can tell you that faith has rescued me from many desperate situations.

 Address to Quaker Youth, Westerly, RI Oct.23,99

Published: February 1, 2000