A pediatric anesthesiologist shares the 15 values that have guided his career.
I am a pediatric intensivist and anesthesiologist. In my clinical work, I take care of critically ill children in the Pediatric Intensive Care Unit (PICU) and the operating rooms. My patients are not only ill children, but also their parents and families are often scared and worried.
My approach to care must be directed towards both the ill child and the family unit. The following 15 commandments for the Pediatric Intensivist and Pediatric Anesthesiologist outline my philosophy and approach to care. A high standard of medical professionalism is my goal. Many facets of this concept which describes the relationship between me and my patients and society are outlined below.
15 Commandments for the Pediatric Intensivist and Pediatric Anesthesiologist
1.) Families, regardless of social status, expect that I be respectful, courteous, and civil.
It is terrifying for families to have a critically ill child as a patient in the unfamiliar environment of a PICU. Sometimes distressed families can understandably be brusque and rude, but I must be respectful, civil, understanding, and accepting.
2.) I must listen to patients and their families and hear not only their narrative but also their fears and wishes. I must support patients and their families. I must be compassionate and must communicate clearly with my patients and their families.
3.) I must be sensitive to cultural values of my patients and their families and be knowledgeable thereof. Issues of death and dying, frequently encountered in the PICU, are imbued with religious and spiritual meaning. I must be familiar with the end of life beliefs and rituals of the major world religions and if I lack this knowledge, I must be humble enough to either ask the patient’s families or the expert clergy on my team to educate me.
4.) I must remember, in my haste and working under pressure, that my patients and their families are scared. I must be empathic, kind, understanding and approachable.
5.) In my care of critically ill patients I must be obsessive, careful, and pay the utmost attention to detail. There is no room for error when taking care of a critically ill child.
6.) My patients and families expect that I am knowledgeable and meet the educational requirements that are expected of my specialty. I owe it to them to be well read and up to date with the developments of my specialty. Since pediatric critical care and anesthesiology are broad ranging specialties, there will be gaps in my knowledge. Introspection is a valuable asset. I must possess humility and be willing to ask for consultation and another opinion. One does not lose authority or respect by asking for help.
7.) I have an obligation to be a teacher as well as a caregiver. Over many years patients have given me knowledge and skills by allowing me to learn from them as I have cared for them. I am obliged and honored to be able to reinvest this knowledge and skill in the next generation of learners.
8.) I must try to be aware of my biases. Confirmation bias may confuse me. I must not close my mind to the possibility that the diagnosis I have made is erroneous. If the clinical course does not seem as predicted, I must be prepared to consider other diagnoses. Pride and lack of flexibility are my enemies.
10.) Critical care and taking care of patients in the PICU and operating room is teamwork. I must be collaborative, ask for and respect the opinion, values and expertise of others, regardless of their specialty or level of training. Other physicians, nurses, technicians and various other team members may have good ideas and may have thought of things I did not consider. I must be willing to consider disparate opinions.
10.) I must create a climate in which everyone feels free to speak up regardless of their position on the team. They must be able to warn the team of something we may have overlooked or of an impending error. Intimidation of team members is not to be tolerated. Hubris is my enemy.
11.) I must be prepared to backup my opinions with evidence. Patients and students are due more than merely my experience. I must encourage inquisitiveness and a search for knowledge in my colleagues, especially amongst trainees.
12.) Modern critical care has saved many patients who would not have survived years ago, but this has gone hand in hand with saving many lives of patients who now have a poor quality of life. Taking care of these patients can be emotionally burdensome to caretakers. I must be sensitive to this moral distress of my colleagues and help to alleviate this.
13.) I must conduct my practice based on the highest ethical principles of autonomy, beneficence, non-maleficence, justice, and caring.
14.) I am obligated to participate in quality improvement projects in order to enhance the quality of care of my patients, present and future.
15.) I am obliged to be a good steward of public resources that are directed towards health care. I must choose wisely in how I deliver care and not be wasteful of society’s limited resources. I have a responsibility to be aware of public policy that affects medical care of the people of our country.