Stoicism, the physician, and care of medical outliers.

Thomas J Papadimos

doi:10.1186/1472-6939-5-8

Abstract

BackgroundMedical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them. The determinism of Stoic thought is explored as an intellectual basis for the pursuit of a correct mental attitude that will provide aid and comfort to physicians who care for medical outliers, thus fostering continued physician engagement in their care.DiscussionThe Stoic topics of good, the preferable, the morally indifferent, living consistently, and appropriate actions are reviewed. Furthermore, Zeno's cardinal virtues of Justice, Temperance, Bravery, and Wisdom are addressed, as are the Stoic passions of fear, lust, mental pain, and mental pleasure. These concepts must be understood by physicians if they are to comprehend and accept the Stoic view as it relates to having the proper attitude when caring for those with long-term and/or costly illnesses.SummaryPracticing physicians, especially those that are hospital based, and most assuredly those practicing critical care medicine, will be emotionally challenged by the medical outlier. A Stoic approach to such a social and psychological burden may be of benefit.

Highlights

Medical outliers present a medical, psychological, social, and economic challenge to the physicians who care for them
Medical outliers are defined in health care reimbursement, especially in the prospective payment system, as those patients who require an unusually long hospital stay or whose stay generates unusually high costs, i.e., the most severely ill [1]
A physician may care for a medical outlier, but it is not necessarily a morally good action if he or she does it without the complete understanding of why it is the right thing to do

Summary

Discussion

The good, the preferable, and the morally indifferent (in "right actions") What is good? Any physician pondering this question may come up with answers such as a lucrative medical practice, minimal on-call days, or passing medical board examinations. A physician may care for a medical outlier, but it is not necessarily a morally good action if he or she does it without the complete understanding of why it is the right thing to do. Though physicians may not be morally perfect (virtuous in the Stoic sense), they know what is "preferable" for their patients, i.e., to get well, go home and be with their families These are morally "indifferent" things, but as Stoics point out, "virtue can consist in the effort to obtain these things. By the mere fact that physicians acknowledge struggles with or against insurers, patients, families, colleagues, ancillary staff, and institutions there is realization that they are part of a "whole", but at the same to "live consistently" requires an understanding of one's role in nature and the need for absence of conflict. Even though Stoicism has evoked controversy for over twenty centuries it is relevant to a physician who must juggle patients, procedures, therapies, and colleagues in the care of a patient who has maximally taxed medical insurers, institutions, other practitioners, and their own families

Background

Summary

13. Arrington RL: Hellenisitic Ethics

Findings

Risse GB

Skowronski GA