Diagnosis for Democracy
Insights into the State of Our Union
A Blog by Rob Tenery, MD


November 10, 2011: Have Physicians Lost Their 'Shared Vision'?

By Rob Tenery, MD on November 10, 2011

There was a time when the practice of medicine was considered a calling. To some, it still is. Unfortunately, to a growing number of physicians, caring for patients is their vocation---a way to ‘make a living.’

Inferred, but not directly stated, a calling comes about though a divine influence over one’s inner soul. It is a field of endeavor where the ultimate goal of those who follow in that path is the fulfillment of a common cause beyond what they receive for their efforts. In medicine, that has been patient benefit.

What separates a calling from a vocation is often the origin of its motivation. Why do individuals choose to undergo the arduous years of sacrifice that would prepare them to take on the responsibilities of the health and wellbeing of others? Most important, what does one perceive as the reward for those efforts? If the answer to these two questions is the satisfaction of helping those who are suffering, to them, medicine is their calling. If their motivation is material benefits, it is their vocation.

Why is the distinction between a calling and a vocation important? Why does it matter that physicians are driven by beneficence rather than self-benefit as long as the results are the same?

One part of that complex answer is ‘shared vision.’ If participants in a given endeavor are more focused on a ‘common good’ rather than personal agendas, the end results usually create more benefit to their mutual goals.

In his book, The Fifth Discipline, Peter Senge, a senior lecturer at MIT, focuses on group problem solving. (1) Although his emphasis pertains to organizations, the same principles can apply to the medical profession. Extracts from his book emphasize several critical points:

  1. Clues to an organization’s deeper purpose can be found in founders’ aspirations and the reasons why the industry came into being.

  2. People see themselves as an inconsequential part of a system over which they have little influence.

  3. The tendency to see things as results of short-term events undermines our ability to see things on a grander scale.

  4. Building shared vision is a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance.


It’s all there: Remembering the tenets upon which this profession was founded, appreciating that each physician can make a difference, understanding the ‘big picture’, and fostering commitment rather than compliance.

In increasing numbers, those entering medicine are not participating in the struggle against the many intrusions that are infecting this profession. It’s not all their fault. Although most medical schools have added ethics lectures to their curriculum, they give only faint encouragement to the obligation of working to preserve the profession---the very place where the seed of ‘shared vision’ should be planted.

Those who become part of any endeavor, in general, make a commitment to follow certain dictums of that endeavor. It might be store clerks who are expected to know their inventory and follow certain norms in dealing with customers. Most important to continue their employment, they must remember they are functioning as representatives of that store and not just their own personal agendas. This principle is one of ‘implied responsibility’ to work not just for a paycheck and their customers, but also for the success and future existence of the store that employs them. This analogy applies to physicians. Many seem to forget or were never taught that they are not an ‘island’ set apart from the rest of the profession. That it is not just about them and their patients. If they aren’t taught that principle early in their training or learn by example from other physicians, more than likely, they never will.

If our forefathers were to judge medicine today, the advances in the science would astound them. Sadly, those same icons, who established this profession, would be disappointed by the many intrusions that are infecting the profession. More important I feel they would be even more disappointed in those physicians that don’t hold on to that ‘shared vision’--- those who just put in their hours, pick up their paychecks and turn their patients over to the next shift without even a look back.

The profession of medicine is in a fight for its life, and currently it is losing. One of the major reasons is that, in growing numbers, its participants have either given up the fight, don’t care as long as their immediate needs are met or were never taught their responsibilities to their profession as they take over from past generations. This goes along with the battles raging in Washington over the budget deficit, the future of Medicare and Social Security. If those freedoms (choices as to how we practice) are lost, we will probably never get them back. And the doctors who follow in our footsteps will pay the price. More important so will their patients.

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1. Senge, PM, The Fifth Discipline. Currency.1990.




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