Author + information
- Valentin Fuster, MD, PhD∗ ()
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
- ↵∗Address correspondence to:
Dr. Valentin Fuster, Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, New York 10029.
Although the classical Hippocratic Oath (1) has received a fair amount of scrutiny, I was reminded of a few lines from this pledge during a recent talk with a group of cardiovascular specialists. A cardiologist asked why the U.S. government was not doing more to defend physicians and why physicians do not have more authority to influence government. I asked this colleague a question that I have asked of others in the past: “Are you advocating for yourself, or are you advocating for your patients?” In our desire to see the most advantageous health care delivery system implemented for clinicians across the United States, could we possibly be losing sight of providing the best care for each of our individual patients? Although I do not claim to know all of the political answers, I do remember the oath that most of us took upon graduating from medical school, which includes a pledge to keep patients “from harm and injustice” and to always be focused on “the benefit of the sick, remaining free of all intentional injustice” (1). Go back and read this oath, my friends.
This discussion invites more pragmatic questions about the current role of physicians and professional societies. Are we here to change society at large, or should we leave this to the politicians? Should the greatest influence that we can have be over the life of just 1 of our patients? If so, why are we not satisfied by this accomplishment? Are we too focused on our own reimbursement or the bottom line?
Irrespective of political party affiliations, I have come to most admire patient advocacy groups, because they tend to maintain focus on the most important end goal—improving the care for patients—and, as a result, have a clearly defined mission to simply support the patient. As defined in a 2010 editorial, “patient advocacy groups are considered important stakeholders in health care policies, patient education, national guideline committees, and scientific research” (2). These groups often maintain the 5 common objectives that are distinctly tailored for patients: to provide psychological support; to educate patients, physicians, and others about the disease; to identify representatives and participate in lobbying; to stimulate research; and to assist in the search for a cure for the disease (2) (Figure 1). These groups seek to accomplish their goals without fame and, oftentimes, without payment.
Although these effective patient groups succeed through a single, unified vision, younger doctors, who are still forming their individual creed by which to treat patients and focus their careers, can have the greatest impact. As I was writing this Editor’s Page last night, I also was preparing to give a keynote lecture for the American Heart Association’s Cardiology Fellows Society of Greater New York, which I founded. While thinking about the classical Hippocratic Oath and appreciating the modern pressures of competition, financial considerations, and incentives, I encouraged these fellows to create an individualized oath as physicians. The title of my presentation was “My Personalized Future: Be Creative and Define Success.” In encouraging the fellows to establish a “Personalized Future,” I recommend that they practice introspection to recognize who they are. I pushed them to invest in what they discover to be their personal talents, along with the assistance of a mentor. As we wrote in 2009, “investment in work that is propelled by your aptitude and passion will be rewarded, whereas investment in something for which you have little talent will lead you through a series of Sisyphean tasks that are ultimately too costly to sustain” (3). In other words, to recognize our own talents and apply them appropriately is the best personal investment you can make, because these will remain constant and present, while the practice of cardiology is in a constant state of rapid change. After identifying these talents, attaining supplemental skill sets is essential for a productive career (3). Once they have invested in their proven talent, I encouraged them to “Be Creative” and to serve the patient and society in a passionate way. As physicians, there is an obligation to be altruistic, because our true calling is to serve patients—and not simply our own patients. Physicians must be rooted in a desire to help humanity through furthering the field of medicine. To “Define [their own version of] Success,” I discouraged them from being too ambitious at any age, because trying to achieve society’s version of success is not prudent and will not lead to true success. Personal fulfillment through succeeding in one’s own talents, accompanied by nurtured altruism, is how physicians can achieve true success. This mindset also fosters the type of physicians who are far more concerned with advocating for the patient, as opposed to advocating for themselves.
- American College of Cardiology Foundation