Should Physicians Come First?

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Do you ever really listen to what a flight attendant says at the beginning of a flight? Something like, “If an oxygen mask appears, put it on yourself before you try to help anyone else, even your child.”

Now, that seems to be the opposite message we get from the latest revision of the AMA's “Principles of Medical Ethics.[1]” The preamble states that “a physician must recognize responsibility to patients first and foremost.” Other responsibilities are secondary, including “to self.”

This extreme emphasis on the patient has not always been the case, either in the United States or other countries. Moreover, it seems like many of the changes in medical practice, especially less time and more management, has increased compassion fatigue, depression, and even suicide in the physician.[2] Perhaps the increased emphasis on the patient was a laudatory attempt to counter any natural reaction on our part to give less attention to the patient.

Nevertheless, research indicates that “burned-out” health clinicians often provide poorer care.[3] Therefore, I would follow the airlines and put clinicians “first and foremost,” not in a narcissistic sense, but in the ethical sense of doing whatever is possible to enhance our ability to practice safely and effectively.[4]

That's my opinion. I'm Dr. Steven Moffic, Professor of Psychiatry at the Medical College of Wisconsin.