Monday, April 26, 2010


In medical school and residency, all of us are vulnerable to influences that will color how we practice and how we approach patients and medicine for the indefinite future.  I tell students that their practice style will be based on things they saw preceptors and teachers do that they choose to emulate, and an active avoidance of things with which the student was uncomfortable.

In school, I read the following comments by G. Gayle Stephens, M.D.  Dr. Stephens was one of the early proponents and defenders of Family Medicine when the specialty (then know as Family Practice) was developing out of the previous general practitioner (GP) model.  I found these ten points spoke very deeply to me, and I have tried to use them as guideposts along the way.  I cannot claim that I was always successful, but I do believe I have done my best.

A Decalogue for Family Practice Residents Entering Practice--G. Gayle Stephens.

  1. Don’t give up the reform ethos.  Keep on the side of responsible change in education, practice, and social justice.

  1. Don’t lose faith in the power of relationships and the therapeutic use of self.  (Or, don’t hire anybody to save you from spending time with patients.)

  1. Don’t turn your practice into a mere business.  It may not be less, and it should be a great deal more.

  1. Learn to distinguish between uncertainty and ignorance; only the latter is remediable and potentially culpable.

  1. Find some way to practice charity; i.e., willingly give a part of your services consistently to those who cannot pay.

  1. Try to see that the groups in which you hold membership are at least as moral as you are.

  1. Humanize and personalize the Microsystems in which you work.

  1. Act at all times as if the patient is fully autonomous; the weaker the patient is, the more vulnerable you are to violating his/her personhood.

  1. Reflect on your professional experiences.  Within the bounds of protecting patients’ privacy, think, talk, and write about your clinical stories.

  1. Worry less about patients becoming overly dependent on you than about your becoming undependable.

 With the increased stresses likely to result from the Patient Protection and Accountable Care Act (PPACA) and as new systems of health care delivery and payment are tested and enacted, I think this ten points will continue to show the way to be a good physician in difficult times.

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