Faithful

Faithful

By

Leonard Zwelling

To me, being faithful is to be loyal, constant, true, and trusted.

Faithfulness is usually described in three contexts—between individuals (wives and husbands), between individuals and institutions (physicians and hospitals), and between individuals and a set of beliefs (people and organized religions).

For me and for my generation of physicians, faithfulness to medicine involved a relationship between each of us as physicians and a core set of beliefs the most important of which was to “do no harm.”

This faithfulness to the Hippocratic Oath and to a whole litany of behaviors and thought processes that put patients above all other concerns and locked the doctor-patient relationship in an unspoken fiduciary agreement that puts the patient first above all else is what we were indoctrinated to believe. Informed consent is such a belief. We had faith in those beliefs. Those beliefs kept us whole in the middle of the night with an alcoholic bleeding from esophageal varices who we were irrigating with iced saline to stem the hemorrhage or when we held the hand of a dying leukemic child. It’s what doctors do. Nurses, too.

At MD Anderson, I have heard faculty espouse a faithfulness to “the institution,” but what is the institution at an academic cancer center?

At any given moment, the institution is its current leadership and thus the institution at places like MD Anderson is not a constant, but ever-changing. Thus, the faithfulness between a faculty member at Anderson and “the institution” should be, by definition, fluid. If the leadership representing the institution proves itself unworthy of that faith, it is the obligation of the faculty to make the leadership aware that its faith to the institution may clash with the more important fiduciary relationship, that between an individual physician and a set of beliefs that, unlike the institution, are unchanging.

We may be at such a moment at MD Anderson.

Recently the institution in the form of its leadership has taken on a set of principles that are incompatible with the provision of patient care consistent with faith to the unchanging principles of good clinical care.

One MD Anderson equates the faculty to the rest of the staff. This is foolishness. There are two things that make MD Anderson unparalleled in the world of cancer care—its name and its faculty. Fool with either, and you may harm the legacy. The putative provision of “MD Anderson” care all over the country and the Houston area is just impossible. The expertise and technology at 1515 Holcombe are not readily replicated elsewhere. This is not to say that the care in the out-lying sites is poor. It’s probably very good, but it is not MD Anderson care. That takes place in the Texas Medical Center

Furthermore, One MD Anderson demeans the value of the faculty. So does the recently pushed notion of professionalism. Does the leadership of “the institution” ever consider why professionalism has arisen as an issue? I have. I have recently written about burnout. So have many others as my blog relates. The stress on the faculty has reached the boiling point. Some are just “quiet quitting,” turning Wednesday into Friday. Others are more actively looking to leave. This may be denied by the institutional leadership, but I believe it to be true.

When I arrived at MD Anderson in 1984, I was immediately struck by the faithfulness people had in each other, in the institutional leadership, and the new motto, “Fighting Cancer. Now that’s a job!” I fear that faith in the institution is ebbing due to the latest leadership and that leadership which had come before it since 2001.

If you want to restore faith in the faculty, treat them as the special asset that they are, realign the institutional values with those of good patient care, and actively pursue the elimination of the cause of burnout (like EPIC and HR computer-based mandatory training).

As W.C. Fields once said, “everybody’s got to believe in something. I believe I’ll have another beer.”

Faith in other people can wane. Faith in institutions ought to be variable depending upon the set of principles guiding the institution. But faith in the tenets of good clinical care do not change and should not. When all three are aligned, professionalism and burnout are no longer points of discussion.