Medical vocation, beyond the duty of care: a review of literature from ethical and philosophical perspectives.

REVIEW ARTICLE

REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2023 - Universidad Ricardo Palma
10.25176/RFMH.v23i3.5635

MEDICAL VOCATION, BEYOND THE DUTY OF CARE: A REVIEW OF LITERATURE FROM ETHICAL AND PHILOSOPHICAL PERSPECTIVES.

VOCACIÓN MÉDICA, MÁS ALLÁ DEL DEBER DE CUIDAR: REVISIÓN DE LA LITERATURA DESDE EL ASPECTO ÉTICO Y FILOSÓFICO

Ayala García Ricardo Jonathan ORCID 1,2,3
Huamaní Huamán Lisset Giuliana ORCID 1,3

1 Universidad Norbert Wiener. Lima, Perú.
2 Clínica Internacional. Lima, Perú.
3 Hospital Nacional Edgardo Rebagliati Martins

ABSTRACT

This review article explores medical vocation as a phenomenon that extends beyond the mere duty of caring for patients, focusing on the significance of ethical commitment, empathy, and resilience in medical practice. The implications for medical training and clinical practice are discussed.

Keywords: Medical vocation; ethics; empathy; resilience; medical education (Source: MeSH – NLM)


RESUMEN

En este artículo de revisión, se examina la vocación médica como un fenómeno que va más allá del simple deber de cuidar a los pacientes y se centra en la importancia del compromiso ético, la empatía y la resiliencia en la práctica médica. Se discuten las implicaciones para la formación de médicos y la práctica clínica.

Palabras clave: Vocación médica, ética, empatía, resiliencia, educación médica (fuente: Decs BIREME)

INTRODUCTION

The medical vocation is a widely recognized concept, in the literature and the practice of medicine, as a special call to dedicate oneself to the care and relief of the suffering of patients (1). Since ancient times, this medical profession has been seen as one of the most noble and altruistic, which stands out for its ethical commitment and responsibility to care for those who need it (2). Over the years, this vocation has evolved and adapted to changes in society and medicine, but the fundamental duty to care remains central to the identity and practice of physicians (3).

Despite the historical importance of the concept of medical vocation, the literature suggests that it goes beyond the simple duty of care and encompasses ethical, humanistic, and emotional aspects essential for effective and compassionate medical practice (4). In this sense, some authors argue that the willingness to study medicine should be seen not only as a call to service, but also as a commitment to clinical excellence, empathy, and resilience in its practice (5,6).

This review presents an overview of the medical vocation literature, in which the importance of ethical commitment, empathy and resilience in the medical profession is highlighted. Likewise, the implications of these findings for the training of physicians and clinical practice are discussed.


MATERIALS AND METHODS

A literature search was performed in academic databases, including PubMed, Scopus, Web of Science, and Google Scholar. The keywords were used: medical vocation, medical ethics, empathy, resilience, and medical education. The search focused on articles, books, and reviews published in English between 1990 and 2022. Relevant studies were selected based on predefined criteria. Inclusion criteria consisted of studies addressing ethics, empathy, and resilience in medical education and clinical practice. Studies that were not directly related to the medical vocation or did not address the issues of ethics, empathy or resilience were excluded. The selected studies were analyzed and relevant information related to the objectives of the review of the article was extracted. The main findings and conclusions of the studies were identified. The information extracted from the studies was synthesized to identify and discuss key themes and sub-themes related to ethics, empathy, and resilience in the medical vocation.


MEDICAL VOCATION

From an ethical and philosophical point of view, the medical vocation can be defined as the internal call and inclination towards medicine based on the desire to serve and care for others and on a deep commitment to integrity, compassion, and professional excellence. This vocation implies not only mastery of technical skills and scientific knowledge, but also adherence to ethical and moral principles that guide the doctor-patient relationship and clinical decision-making (6,7).


ETHICAL COMMITMENT IN MEDICAL VOCATION

Fundamental ethical principles in medical practice

Medical ethics is integral to the medical vocation and implies adherence to principles that guide clinical practice. The four fundamental ethical principles are autonomy, beneficence, non-maleficence and justice (7). These principles help physicians make ethical decisions in clinical situations and keep the welfare and rights of patients at the forefront.


The relationship between ethics and medical vocation

Ethics and the medical vocation are closely related since ethical commitment is a fundamental part of being a doctor (7). The duty to care for patients in an ethical and professional manner is central to the medical vocation, and ethical practice contributes to a sense of purpose and satisfaction in the medical profession (8).

Contemporary medicine presents numerous ethical challenges, such as equity in access to medical care, patient confidentiality, end-of-life decision-making, and fair distribution of limited resources (9). These challenges require physicians to engage with ethics constantly and reflect on their professional values ​​and responsibilities.


The importance of ethics education in undergraduate medical training

Ethics education is essential to prepare future doctors to face ethical and professional challenges in their practice (10). Ethics training should be an integral part of the medical curriculum, including theoretical teaching and opportunities for reflection and experiential learning in clinical settings (11).


Empathy and human connection in medical vocation

Definition and aspects of empathy in medical practice

Empathy is the ability to understand and share the feelings of others, which allows physicians to establish effective therapeutic relationships with their patients (4); in medical practice, it involves not only a cognitive understanding of patients' experiences, but also the ability to respond emotionally to their needs (12).

Impact of empathy on clinical outcomes and patient satisfaction

Research has shown that empathy in the doctor-patient relationship is associated with better clinical outcomes, greater patient satisfaction, and better adherence to treatment (13,14). Additionally, empathic physicians are less likely to experience burnout and have higher job satisfaction (15).

Strategies to foster empathy in medical education and clinical practice

The teaching and development of empathy in medical education and clinical practice can be addressed through specific pedagogical approaches, such as patient-centered communication, narrative-based education, and mindfulness skills training (16,17,18). In addition, feedback and reflection on clinical experiences can help physicians improve their empathic skills and maintain their ability to connect with patients throughout their careers.

Barriers and challenges to maintaining empathy in demanding medical settings

Clinicians may face barriers and challenges in maintaining empathy in demanding medical environments, such as time pressure, burnout, and the emotional demands of caring for seriously ill patients (12,19,20). To address these challenges, it is important to encourage self-care and peer support and promote work-life balance with medical personnel.


Resilience and coping in the medical vocation

Definition and components of resilience in the medical context

In the medical context, resilience refers to the ability to adapt and recover from difficulties and stress in medicine (23); it includes components such as adaptability, active coping, social support, and self-care (22).

Importance of resilience in preventing burnout and promoting well-being

Resilience is essential to prevent burnout and promote well-being among physicians, as it enables them to deal effectively with the challenges and demands of their profession (23). Research has shown that resilient physicians have higher job satisfaction, better quality of life, and lower risk of burnout (24).

Strategies to foster resilience in medical education and clinical practice

Resilience can be fostered in medical education and clinical practice through targeted interventions, such as coping skills training, self-care education, and supporting connections with colleagues and mentors (25,26). In addition, the development of emotional intelligence skills and the cultivation of mindfulness, too, can contribute to resilience in the medical profession (27,28).

Challenges and barriers to developing and maintaining resilience in the practice of medicine

Building and maintaining resilience in medicine can be difficult, due to factors such as high workload, emotional demands, and lack of institutional support. To address these challenges, it is necessary to promote changes in the work environment and in the culture of medicine, such as the implementation of work-life balance policies, the promotion of interprofessional collaboration and the promotion of the importance of well-being among doctors (29).


Integration of ethics, empathy and resilience in medical education and clinical practice

Pedagogical approaches and strategies for teaching ethics, empathy and resilience in medical education

Integrating ethics, empathy, and resilience into medical education can be achieved through pedagogical approaches such as case-based teaching, reflective learning, and experiential education (30,31). In addition, collaborative teaching techniques such as peer learning and group discussions can facilitate the development of ethical, empathic, and resilient skills among medical students (32).


The importance of self-care and institutional support in promoting a comprehensive medical practice

Self-care and institutional support are crucial to promoting a comprehensive medical practice incorporating ethics, empathy, and resilience (33). This includes providing resources and training in self-care, offering opportunities for supervision and mentoring, and fostering a work environment that values ​​the importance of well-being and job satisfaction (34).


Evaluation of the effectiveness of interventions to improve ethics, empathy and resilience in medical education and clinical practice

Research on the effectiveness of interventions to improve ethics, empathy, and resilience in medical education and clinical practice is essential to inform and adapt educational and support strategies (35). Assessments can include quantitative and qualitative measures of ethical, empathic, and resilient skills and long-term outcomes related to job satisfaction and well-being (36).

Future challenges and opportunities to integrate ethics, empathy and resilience in medicine

Future challenges and opportunities for integrating ethics, empathy, and resilience into medicine include adapting to changes in medical practice, such as increased use of technology and telemedicine and attention to diversity and inclusion in medical care (37). In addition, continued research and development of new educational and support strategies will be essential to address these challenges and seize opportunities to improve ethics, empathy, and resilience in medical education and clinical practice (38).


Table 1. Evaluation and challenges

How do we review it?

What are the challenges?

Medical ethics

Questionnaires and reflections on difficult situations

Making ethics a natural part of medical education and keeping it relevant in an ever-changing medical world

Medical empathy

Communication practices with patients and self-assessments

Teach empathy in a measurable way, and prevent emotional exhaustion.

Medical resilience

Mindfulness techniques and stress questionnaires

Help clinicians manage stress without ignoring stress-producing health system issues



The medical vocation has been examined beyond the simple duty of care and has focused on critical aspects such as ethics, empathy and resilience in medical training and clinical practice. We have reviewed the literature emphasizing topics such as the importance of ethics and empathy in the doctor-patient relationship, the implications of resilience on job satisfaction and well-being of physicians, and pedagogical and support strategies to integrate these concepts. in medical education and practice.

Nevertheless, it is essential to recognize that the medical vocation is a constantly evolving field and that future challenges and opportunities must be proactively addressed. For example, the increased use of technology and telemedicine could have significant implications for how ethics, empathy, and resilience are taught and practiced in medicine. Similarly, the recognition of diversity and inclusion in healthcare and medical education is an area in which more attention and a holistic approach are needed.

Ultimately, the purpose of this review article is to highlight the importance of going beyond duty of care and to encourage a more comprehensive approach to medical education and practice. By doing so, we can support physicians on their path to a more ethical, empathetic, and resilient medical practice, which in turn can improve the quality of care and satisfaction for both patients and physicians.

The medical vocation is an area of ​​study and practice that deserves continuous attention and commitment from educators, physicians, and health institutions. By proactively and thoughtfully addressing these issues and challenges, the well-being and satisfaction of our physicians can be improved and ensure more compassionate and effective healthcare for patients.


CONCLUSIONS

The medical vocation goes far beyond the simple duty to care; it implies an ethical commitment, empathy, human connection, and resilience to face the challenges inherent in the practice of medicine. Integrating these components, into medical education and clinical practice, is essential to promote comprehensive and successful medical practice and to ensure that physicians are prepared to address professional and ethical challenges in the care of their patients.



Authorship contributions: RAG participated in the conception and design of the article, selection, and review of the bibliography, writing and critical review of the article, and approved the final version. LHH, participated in the review of the bibliography and writing of the article.
Financing: The research was self-funded.
Declaration of conflict of interest: None.
Received: May 24, 2023
Approved: June 14, 2023


Correspondence author: Ricardo Jonathan Ayala García
Address: Av. Prolongación Iquitos 1542 Dpto 1503, Lince, Lima, Perú.
Phone: +51 961066414
E-mail: ricardo.ayala@medicos.ci.pe; ricardo.ayala@uwiener.edu.pe


Article published by the Journal of the faculty of Human Medicine of the Ricardo Palma University. It is an open access article, distributed under the terms of the Creatvie Commons license: Creative Commons Attribution 4.0 International, CC BY 4.0 (https://creativecommons.org/licenses/by/1.0/), that allows non-commercial use, distribution and reproduction in any medium, provided that the original work is duly cited. For commercial use, please contact revista.medicina@urp.edu.pe.


BIBLIOGRAPHIC REFERENCES

    Brody H, Doukas D. Professionalism: a framework to guide medical education. Med Educ 2014;48:980-7. https://doi.org/10.1111/medu.12520 .
    2. Cruess RL, Cruess SR. Teaching Medical Professionalism: Supporting the Development of a Professional Identity. Cambridge University Press; 2018.
    3. Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA 2002;287:226-35. https://doi.org/10.1001/jama.287.2.226
    4. Hojat M, Louis DZ, Markham FW, Wender R, Rabinowitz C, Gonnella JS. Physicians’ empathy and clinical outcomes for diabetic patients. Acad Med 2011;86:359-64. https://doi.org/10.1097/ACM.0b013e3182086fe1
    5. Ludmerer KM. Let me heal: The opportunity to preserve excellence in American medicine. Oxford University Press; 2015.
    6. Pellegrino ED, Thomasma DC. A philosophical basis of medical practice: Toward a philosophy and ethic of the healing professions. Oxford University Press; 1981.
    7. Beauchamp TL, Childress JF. Principles of biomedical ethics. Oxford University Press; 2013.
    8. Cruess RL, Cruess SR, Steinert Y. Medicine as a community of practice: Implications for medical education. Acad Med 2018;93:185-91. https://doi.org/10.1097/ACM.0000000000001826
    9. Lo B. Resolving ethical dilemmas: A guide for clinicians. Lippincott Williams & Wilkins; 2013.
    10. Goldie J. The formation of professional identity in medical students: considerations for educators. Med Teach 2012;34:e641-8. https://doi.org/10.3109/0142159X.2012.687476
    11. Eckles RE, Meslin EM, Gaffney M, Helft PR. Medical ethics education: where are we? Where should we be going? A review. Acad Med 2005;80:1143-52. https://doi.org/10.1097/00001888-200512000-00020
    12. Decety J, Jackson PL. The functional architecture of human empathy. Behav Cogn Neurosci Rev 2004;3:71-100. https://doi.org/10.1177/1534582304267187.
    13. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Eval Health Prof 2004;27:237-51. https://doi.org/10.1177/0163278704267037 .
    14. Rakel D, Barrett B, Zhang Z, Hoeft T, Chewning B, Marchand L, et al. Perception of empathy in the therapeutic encounter: effects on the common cold. Patient Educ Couns 2011;85:390-7. https://doi.org/10.1016/j.pec.2011.01.009
    15. Shanafelt TD, Boone S, Tan L, Dyrbye LN, Sotile W, Satele D, et al. Burnout and satisfaction with work-life balance among US physicians relative to the general US population. Arch Intern Med 2012;172:1377-85. https://doi.org/10.1001/archinternmed.2012.3199
    16. Kelm Z, Womer J, Walter JK, Feudtner C. Interventions to cultivate physician empathy: a systematic review. BMC Med Educ 2014;14:219. https://doi.org/10.1186/1472-6920-14-219
    17. Charon R. The patient-physician relationship. Narrative medicine: a model for empathy, reflection, profession, and trust. JAMA 2001;286:1897-902. https://doi.org/10.1001/jama.286.15.1897
    18. Dobkin PL, Hutchinson TA. Teaching mindfulness in medical school: where are we now and where are we going? Med Educ 2013;47:768-79. https://doi.org/10.1111/medu.12200
    19. Lown BA, Muncer SJ, Chadwick R. Can compassionate healthcare be measured? The Schwartz Center Compassionate Care ScaleTM. Patient Educ Couns 2015;98:1005-10. https://doi.org/10.1016/j.pec.2015.03.019
    20. Gleichgerrcht E, Decety J. Empathy in clinical practice: how individual dispositions, gender, and experience moderate empathic concern, burnout, and emotional distress in physicians. PLoS One 2013;8:e61526. https://doi.org/10.1371/journal.pone.0061526
    21. Howe A, Smajdor A, Stöckl A. Towards an understanding of resilience and its relevance to medical training: Resilience and its relevance to medical training. Med Educ 2012;46:349-56. https://doi.org/10.1111/j.1365-2923.2011.04188.x
    22. Epstein RM, Krasner MS. Physician resilience: what it means, why it matters, and how to promote it. Acad Med 2013;88:301-3. https://doi.org/10.1097/ACM.0b013e318280cff0
    23.West CP, Dyrbye LN, Erwin PJ, Shanafelt TD. Interventions to prevent and reduce physician burnout: A systematic review and meta-analysis. The Lancet 2016;388:2272-81.
    24. Dyrbye LN, Thomas MR, Shanafelt TD. Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic Medicine 2006;81:354-73.
    25. Shapiro SL, Astin JA, Bishop SR, Cordova M. Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. Int J Stress Manag 2005;12:164-76. https://doi.org/10.1037/1072-5245.12.2.164
    26. Panagioti M, Panagopoulou E, Bower P, Lewith G, Kontopantelis E, Chew-Graham C, et al. Controlled interventions to reduce burnout in physicians: A systematic review and meta-analysis: A systematic review and meta-analysis. JAMA Intern Med 2017;177:195-205. https://doi.org/10.1001/jamainternmed.2016.7674
    27. Goleman D. Emotional intelligence: Why it can matter more than IQ. Bantam Books; 1995.
    28. Kabat-Zinn J. Mindfulness-based interventions in context: Past, present, and future. Clin Psychol (New York) 2003;10:144-56. https://doi.org/10.1093/clipsy.bpg016
    29. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet 2009;374:1714-21. https://doi.org/10.1016/S0140-6736(09)61424-0
    30. Branch WT, Pels RJ, Hafler JP. Teaching medical students and residents how to work with difficult patients. Journal of General Internal Medicine 1997;12:715-8.
    31. Wald HS, Borkan JM, Taylor JS, Anthony D, Reis SP. Fostering and evaluating reflective capacity in medical education: developing the REFLECT rubric for assessing reflective writing. Acad Med 2012;87:41-50. https://doi.org/10.1097/ACM.0b013e31823b55fa
    32. Dornan T, Hadfield J, Brown M, Boshuizen H, Scherpbier A. How can medical students learn in a self-directed way in the clinical environment? Design-based research. Med Educ 2005;39:356-64. https://doi.org/10.1111/j.1365-2929.2005.02112.x
    33. Shapiro J, Morrison E, Boker J. Teaching empathy to first year medical students: evaluation of an elective literature and medicine course. Educ Health (Abingdon) 2004;17:73-84. https://doi.org/10.1080/13576280310001656196
    34. Sinsky CA, Willard-Grace R, Schutzbank AM, Sinsky TA, Margolius D, Bodenheimer T. In search of joy in practice: a report of 23 high-functioning primary care practices. Ann Fam Med 2013;11:272-8. https://doi.org/10.1370/afm.1531
    35. Dewa CS, Loong D, Bonato S, Trojanowski L, Rea M. The relationship between resident burnout and safety-related and acceptability-related quality of healthcare: a systematic literature review. BMC Med Educ 2017;17:195. https://doi.org/10.1186/s12909-017-1040-y
    36. Lavezzoli G, Curcio G, Hawkins M, Anastasi F. A mixed methods evaluation of adult tier 2 weight management service provision across a county in Northern England. BMC Health Services Research 2017;17.
    37. Wartman SA, Combs CD. Reimagining medical education in the age of AI. AMA J Ethics 2019;21:E146-152. https://doi.org/10.1001/amajethics.2019.146
    38.Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. Lancet 2010;376:1923-58. https://doi.org/10.1016/S0140-6736(10)61854-5



http://www.scielo.org.pe/scielo.php?script=sci_serial&pid=2223-2516&lng=en&nrm=iso


Do you want to leave your comment or suggestion about this article?

CLICK HERE