Physicians Who Fail: Understanding Why and Starting the Journey Back

I just spent three days last weekend attending, and in some small part helping to teach, a seminar on Professional Boundaries for physicians. Each of the attendees had their own story of how they had crossed a boundary or had done something unethical and each were there discovering new things about themselves, and learning, usually for the first time, the fundamental principles of Medical Ethics and Boundaries. It is not easy being a physician in Twenty-first Century America. It is a profession that is respected, and privileged; but, it isn't easy. We grow up watching "House" and "ER" and wanting to help other people. We become physicians and are given respect and trust and great power to do good and to help other people. But it doesn't take very long to realize that medicine is hard work, is never "television glamorous", is often full of self doubt and can be a very lonely place. Sometimes it is simply too easy to forget that the medical license we have worked so hard to earn is granted to us as a privilege and not a right. We don't see our own vulnerabilities, and we become "work blind" to circumstances around us that put us at risk. And, we end up harming the patients we have taken an oath to help.

"A fiduciary duty is a legal duty to act solely in another party's interests." https://www.law.cornell.edu/wex/fiduciary_duty

I never heard the words "fiduciary duty" when I was in medical school, or my residency, nor during most of my medical career. Yet it is the physician's role as fiduciary that is at the heart of the physician-patient relationship. It is the foundation from which all other principles of medical ethics arise. I didn't know what the phrase "fiduciary duty" meant until I had to look it up, having to confront my own failure in that duty myself.

So I spent a weekend with this small group of physicians, who were working through their failures and discovering again who they always meant to be as healers. I listened as they put together the pieces of their own plans on how to be wiser and safer physicians in the future. And I remembered how years ago, I sat around a similar table, and worked though my own failures, and started on my own journey back to being the physician I had always wanted to be.