The Virtuous Physician by James A. Marcum

Author:James A. Marcum
Language: eng
Format: epub
Publisher: Springer Netherlands, Dordrecht

4.1.4.2 Peabody’s Notion of Patient Care

The virtue of care and the ethics of care are instrumental in the practice of contemporary healthcare (Benner, 1997; Cates and Lauritzen, 2001; Tong, 1998). Francis Peabody, an early twentieth century Boston City Hospital clinician and Harvard Medical School professor, best illustrates this ontic virtue’s relevance for healthcare.9 In a lecture entitled, “The care of the patient,” delivered at Harvard Medical School, Peabody warns his audience that both the science of medicine and its art are not antagonistic enterprises but rather supplementary or complementary to each other. In other words, physicians must not only know the disease mechanism of an illness but they must also understand what that disease means in terms of the patient’s illness experience and life. As Peabody so famously articulates his position at the conclusion of the paper, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient” (1927, p. 882). The underlying quality or virtue of a good clinician is a general interest in humanity at large and in patients specifically. Without that broad interest in the human condition in which people share, according to Peabody, clinicians cannot adequately help patients because they cannot connect with them to form a genuinely caring human relationship. Thus, clinicians must first be motivated to help or care about (care1) patients before they can help or take care of (care2) them. In other words, clinicians must connect with their patients at a rudimentary level emotionally or existentially to care for them effectively.

To take care2 of the patient, according to Peabody, requires a rather comprehensive “clinical picture” of the patient. He claims that this picture is “not just a photograph of a man sick in bed; it is an impressionistic painting of the patient surrounded by his home, his work, his relations, his friends, his joys, sorrows, hopes, and fears” (1927, p. 878). Given this picture’s complexity, the forces that have an impact on the patient’s illness experience are simply more than just the organic, rather they may also include the psychological, the emotional, or even the spiritual. The physician must be motivated (care1) and equipped (care2) to deal with or care for all the forces influencing the patient’s illness experience and medical outcome. Using another analogy, Peabody encourages clinicians to use low-power magnification initially to understand patients and their world, especially their world of illness, before switching to high-power to determine the disease’s etiology and treatment. Moreover, Peabody realizes that physicians cannot single-handedly treat patients in a comprehensive fashion. Other members of a healthcare team must also play their part. For example, he notes that after a physician listens to the economic concerns of a patient with heart disease the clinician must then refer the patient to a social worker who can then help, for instance, the patient find appropriate employment. Thus, to care about (care1) and to take care of (care2) the patient involves not only a desire to help the patient but also an ability to do so.

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