It is a Privilege

“It is a privilege to be a physician.”

I first heard that phrase in an “Unsolicited Advice” lecture during Clinical Skills Course, just before starting rotations. I’m sure there was some eye-rolling going on in the class, but I kind of liked it. At least, I liked the idea of it. If nothing else, an optimistic view of life…

So I wrote it down and promised myself I would look at it every once in a while over the coming year. Everything from the internet to senior students to Practice Course had told me that rotations would burn me out, and I thought I might need something to refresh my optimism in the near future.

Imagine my surprise, then, when I heard that exact phrase less than two weeks later, during my very first day of internal medicine. As my team sat in the workroom going over our patient list, someone commented that our list contained a fairly high prevalence of IV drug users and alcoholics (there is, from time to time, a negative stereotype associated with these patients).  Without pause, the attending physician smiled, raised his eyebrows, and said, “Ya know, it is a privilege.” It would have been the perfect sarcastic response to propagate the comment’s implications… but it was totally sincere.

I thought it was a striking coincidence to hear that phrase repeated so genuinely in a clinical setting. If I didn’t have it on my mind that night, I certainly did by the end of the week; the attending continued dropping that line, every day we were on service together.

“It is a privilege to do what we do.”

“People are pretty amazing, and we are privileged to see it.”

“It is a privilege…”

It’s hard to write that phrase without feeling… cheesy. And maybe even a little self-righteous. At the very least, it can sound painfully positive.

Yet… as with many things, repetition makes it real.

A couple days into the rotation, the attending and I left the room of a patient who was truly down on his luck, in the hospital for a place to sleep as much as he was for any medicines. As the attending walked away, he made a joke about the patient’s request for a cigarette, smiled, and said, “It is a privilege to take care of people.” The rest of the morning, as I power-walked the hallways of Duke North in search of something to do, I found my brain playing the phrase on loop. And for some reason, while it rolled around inside my head that morning, it cemented for me.

Later that month, I was helping admit a patient having a sickle cell pain crisis, another negatively stereotyped patient. It really resonated when he said, “Man, I wouldn’t come anywhere else for this. I trust ya’ll to take care of me and give me respect.” We couldn’t promise to completely take away his pain, and he knew it. But we could promise that we’d keep a close eye on him and listen to what he had to say. That was the next best thing, and what he was hoping for. That level of trust is pretty cool, and the opportunity to hold someone’s trust like that is something I previously would have only anticipated to come from the very closest of relationships.

So it is a privilege to take care of patients, just as it is a privilege to take care of friends and loved ones. When a best friend calls me to tell me they’re going through a break-up, it’s my duty to provide beer (or ice cream, as the situation merits) and consolation. Likewise, when my sister calls me in the middle of the night from a different time zone freaking out about something that can probably wait until morning, it’s my responsibility to calm her down and make sure she’s all right.

In both of these cases, however, there’s more to it than just the responsibility. I feel privileged to be the person they turn to, just as I feel privileged to be able to help them out in some small way. That’s what makes the relationship what it is. And while I can hope that beer will magically cure my friend of his break-up blues (unfortunately clinical trials have been equivocal thus far), it’ll more likely just be my presence and availability that really helps.

In the same vein, there is real privilege in being in the profession that people look to for medical needs – the profession that people think will take care of them. We hope that what we do in the hospital will provide for that medical need, and it is certainly rewarding when it does. The great privilege, though, comes simply from being the ones that people turn to; the great reward comes from simply taking care of people, whatever that means… including refusing requests for cigarettes.

“It is a privilege…”

So it may be cheesy, but I’ve also come to think it’s true. And it’s no longer just the idea of it that I like.