Professional Promises

Abstract

“What do you notice?” we asked our cohort of 23 incoming interns. The group sat together on their first day of orientation in a darkened room and gazed at a large, projected image of David's painting.“Just describe what you see,” we said. One by one, the interns offered their observations.“There are 3 men dressed in uniform on the left, raising their arms toward some sort of authority figure in the center, who is holding 3 swords. Perhaps the men are going off to battle.”“I can see that one of the men has his arm clasped around the back of another—it is as if the 3 men are united in something they are about to do.”“The men look strong and resolute. The women on the right seem distressed. I get the idea that they must be related in some way to these men, and the women seem anxious about what the men are about to do.”“Unlike the women, the children do not look scared—they seem curious and interested and open.”“The way the light comes down in the center of the painting makes it seem like what these men are doing is sacred in some way, sort of suggesting the presence of the divine.”We probed a little deeper. “In what ways does this painting resonate with the journey you are embarking on as new doctors? In what ways do you find yourself resistant to the painting and its narrative?”Commissioned at the time of the French Revolution, the canvas (figure) depicts a scene from an ancient story about a conflict between Rome and neighboring Alba, Italy. In the tale, the cities elect to resolve the conflict by choosing 3 brothers from the Horatii family in Rome and sending them to battle with 3 brothers from the Curiatii family in Alba. The drama is animated by the 2 families being linked through marriage—a sister in each family is married to a brother in the other. We used the image to open a conversation among our new trainees about promises in professional life.We expanded the conversation about oaths with a few additional images: a bodhisattva who earns the opportunity to leave this world of suffering but vows instead to stay on earth and help other sufferers reach enlightenment; Barack Obama with his hand on the Bible in front of Chief Justice John Roberts; 2 men pledging love for one another in a marriage ceremony. Our collective understanding about oaths deepened.We asked these incoming residents to share stories of physicians who had been role models for them. “What core commitments,” we asked, “drive these physicians you admire? Can you intuit—from the behaviors you have witnessed and the words you have heard—what promises they seek to keep?”“To whom,” we asked, “must a physician make promises?” We listed them on the board as interns called them out: ourselves, our patients, our colleagues, our friends and families, the care system in which we practice, the state that licenses us, among others.The conversation was lively by the time the interns broke into 4 smaller groups to draft oaths of their own. Volunteers crafted the 4 draft oaths into a single statement. The night before they started internship, at a party with faculty and other residents, their families and friends, they stood—crisp, new, white coats still creased—and read their oath aloud.It was a beautiful way to start a year that will inevitably be challenging and intense. Working together to name their intentions as physicians was ennobling and inspiring, we think. The exercise somehow brought David's light into the room to shine on these new physicians' metaphorically outstretched hands and upward-looking faces. Crafting a collective statement bound them together—like the 3 brothers in David's painting—before we handed them the sharp and dangerous tools of their trade. They wisely saw themselves in both David's women and David's men and pledged themselves as healers to wholeness in their personal lives as well.Of course, the ceremonial recitation is just a beginning. Promises like these are hard to keep. Our new interns will inevitably disappoint themselves, their patients, their families, their colleagues, and others; hopefully, they will continue to reflect, to seek forgiveness, to pledge themselves anew. If we serve them well as teachers, we will help them return again and again to these promises. We will help them to notice what nurtures and what thwarts them in their desire to be true to these core relational commitments. We will encourage them to grow as leaders who are empowered to change the conditions that constrain their ability to keep the professional promises they hold most dear. With experience, they will learn how to make even better promises—promises that deliver not only good intentions but also good outcomes.