What Does It Mean to Be a Physician?

The practice of medicine is founded on a simple transactional relationship between the physician and the patient. The role of the physician has always been one of gathering patient data and treating disease, of caring and curing, and of bringing science and humanism together to benefit patients. This role has defined the profession across time and cultures. The continuity of clinical information was often dependent on the continuity of the relationship, with clinical data documented only to the degree necessary to inform memory.

Physicians were seen as community resources, but they were not responsible for community problems. Physicians focused on medical diseases and the patients who had them, not the larger world that the patients inhabited. They were often “married to their careers,”1 sometimes to the detriment of their family responsibilities and personal health, but their job was clear. Now the job is not at all clear with the emergence of new themes of population health, health equity, social determinants of health, and work-life balance.

Most physicians have traditionally relied on their own talents and skills to meet their decision-making responsibilities, and are modest about their successes and accountable for their failures. Their work life is characterized by the cumulative effect of thousands of individual patient encounters. Medical students are selected for these traits and talents, which are then enhanced during training.

That simple role is now being challenged. Modern physicians have expectations and responsibilities not experienced by their predecessors. These expectations may seem to be natural extensions of the physician’s responsibility and incrementally appropriate, but the cumulative effect is to radically alter the traditional ways that physicians have functioned. The result is a high level of identity confusion, leading to professional dysphoria and dissonance.

These disruptive forces derive from at least 4 sources: (1) a dysfunctional, profit-driven health care system that requires physicians to fulfill nonclinical functions; (2) changes in physician expectations regarding work commitments and income; (3) disruptions in relational and information continuity with patients; and (4) failure of the public health system.

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