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Medicine, Health Care and Philosophy

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01.05.2011 | Scientific Contribution

Care and competence in medical practice: Francis Peabody confronts Jason Posner

verfasst von: James A. Marcum

Erschienen in: Medicine, Health Care and Philosophy | Ausgabe 2/2011

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Abstract

In this paper, I discuss the role of care and competence, as well as their relationship to one another, in contemporary medical practice. I distinguish between two types of care. The first type, care₁, represents a natural concern that motivates physicians to help or to act on the behalf of patients, i.e. to care about them. However, this care cannot guarantee the correct technical or right ethical action of physicians to meet the bodily and existential needs of patients, i.e. to take care of them—care₂. To that end, physicians must be competent in the practice of medicine both as evidence—based science (technical competence) and as patient—centered art (ethical competence). Only then, I argue, can physicians take care of (care₂) patients’ bodily and existential needs in a compassionate and comprehensive manner. Importantly, although care₁ precedes competence, competence—both technical and ethical—is required for genuine care₂, which in turn reinforces an authentic care₁. I utilize the play Wit, especially the character Jason Posner, and Francis Peabody’s exposition on caring for patients, to illustrate the role of care and competence in contemporary medical practice.

In 1999, Edson won a Pulitzer Prize for Wit, and, in 2001, the play was made into an HBO movie. Emma Thompson stars as Vivian Bearing, Christopher Lloyd as Harvey Kelekian, Jonathan Woodward as Jason Posner, and Audra McDonald as Susie Monahan. Mike Nichols was the director of the film, which was nominated for two Golden Globes.

The notion is also central to contemporary ethics of care (Pettersen, 2008; Slote, 2007).

Mayeroff’s notion of caring operates differently depending on context. For example, in terms of parenting caring involves an intimacy and affection not found in professional relationships such as the patient-physician relationship. I thank an anonymous reviewer for pointing out this distinction.

Mayeroff adds that one can take care of not only persons but also things, such as an idea or a physical object.

Stan van Hooft (1996) also identifies care as motivational and behavioral.

Unfortunately, the locution “to care for” is ambiguous in the English language—as evident from the discussion on the notion of care thus far. On the one hand, to care for is motivational, i.e. one cares for another person as a person, while on the other hand it is behavioral, i.e. one cares for the needs of another person. Because of this ambiguity, I avoid this locution in discussing the two types of care for the rest of the paper and confine care₁ to the locution “to care about” and care₂ “to take care of.”

Trust here refers to more than simple reliance upon a physician’s skill, but more importantly, it represents an attitude of deeply felt faith in the physician as a caring and competent person who can meet a patient’s overall medical needs. I thank an anonymous reviewer for pointing out this distinction.

I thank an anonymous reviewer for this clarification.

The movie version of Wit differs from the written play in that Posner enters the room, introduces himself to Vivian directly, and shakes her hand.

The placebo example does not imply that the justification for care₂ is simply instrumental. Care₂ is also justifiable per se in the sense that it undergirds the goal of medicine to alleviate suffering (Cassell 2004). For further discussion of the placebo effect, see Brody (2000) and Harrington (1997).

Of course, Peabody did not discuss the role of narrative in medical practice but his notion of patient qua impressionistic painting presages current emphasis on the role of narrative in medicine. For reviews of narrative in contemporary medical practice, see Brody (2003), Charon (2006), Kleinman (1988), and Montgomery Hunter (1991).

According to Frank, “The plot of the restitution [narrative] has the basic storyline: ‘Yesterday I was healthy, today I am sick, but tomorrow I’ll be healthy again’” (1995, p. 77).

Frank (1995) identifies a third story form, the chaotic narrative, which is often fragmented and a-temporal in nature—reflecting a patient’s intense pain and suffering and inability to find meaning in the illness story.

Vivian does revisit her life and now feels contrition for the many times she failed to grant the touch of human kindness, which she now desperately seeks for herself from healthcare professionals, to her students. Through this process, she is growing as a human being and reinventing herself in terms of what her life means or should have meant.

Brody, H. 2000. The placebo response: How you can release the body’s inner pharmacy for better health. New York: Cliff Street Books.

Brody, H. 2003. Stories of sickness, 2nd ed. New York: Oxford University Press.

Carraccio, C., R. Englander, S. Wolfsthal, C. Martin, and K. Ferentz. 2004. Educating the pediatrician of the 21st century: Defining and implementing a competency-based system. Pediatrics 113: 252–258.PubMedCrossRef

Cassell, E.J. 2004. The nature of suffering and the goals of medicine, 2nd ed. New York: Oxford University Press.

Charon, R. 2006. Narrative medicine: Honoring the stories of illness. New York: Oxford University Press.

Edson, M. 1999. Wit. Dramatists Play Service, Inc: New York.

Epstein, R.M., and E.M. Hundert. 2002. Defining and assessing professional competence. Journal of American Medical Association 287: 226–235.CrossRef

Eriksson, S., G. Helgesson, and A.T. Höglund. 2007. Being, doing, and knowing: Developing ethical competence in health care. Journal of Academic Ethics 5: 207–216.CrossRef

Frank, A.W. 1995. The wounded storyteller: Body, illness, and ethics. Chicago: University of Chicago Press.

Good, M.-J.D. 1998. American medicine: The quest for competence. Berkeley: University of California Press.

Harrington, A. (ed.). 1997. The placebo effect: An interdisciplinary exploration. Cambridge: Harvard University Press.

Jecker, N.S., and W.T. Reich. 2004. Care: Contemporary ethics of care. In Encyclopedia of bioethics, ed. Post S.G., 3rd edn, vol 1, 367–374. New York: Thomson Gale.

Jormsri, P., W. Kunaviktikul, S. Ketefian, and A. Chaowalit. 2005. Moral competence in nursing practice. Nursing Ethics 12: 582–594.PubMedCrossRef

Kleinman, A. 1988. The illness narratives: Suffering, healing, and the human condition. New York: Basic Books.

Larkin, G.L., M.P. McKay, and P. Angelos. 2005. Six core competencies and seven deadly sins: A virtue-based approach to the new guidelines for graduate medical education. Surgery 138: 490–497.PubMedCrossRef

Mayeroff, M. 1971. On caring. New York: Harper and Row.

Montgomery Hunter, K. 1991. Doctors’ stories: The narrative structure of medical knowledge. Princeton: Princeton University Press.

Noddings, N. 1984. Caring: A feminine approach to ethics and moral education. Berkeley: University of California Press.

Paul, O. 1991. The caring physician: The life of Dr. Francis W. Peabody. Boston: The Francis A. Countway Library of Medicine.

Peabody, F.W. 1927. The care of the patient. Journal of American Medical Association 88: 877–882.

Peabody, F.G. 1933. Francis Weld Peabody 1881–1927. A memoir. Cambridge: Riverside Press.

Pettersen, T. 2008. Comprehending caring: Problems and possibilities in the ethics of care. Lanham: Lexington Books.

Reich, W.T. 2004. Care: History of the notion of care. In Encyclopedia of bioethics, ed. Post S.G., 3rd edn, vol 1, 349–364. New York: Thomson Gale.

Slote, M. 2007. The ethics of care and empathy. New York: Routledge.

Toombs, S.K. 1993. The meaning of illness: A phenomenological account of the different perspectives of physician and patient. Norwell: Kluwer.

van Hooft, S. 1996. Bioethics and caring. Journal of Medical Ethics 22: 83–89.PubMedCrossRef

Titel: Care and competence in medical practice: Francis Peabody confronts Jason Posner
verfasst von: James A. Marcum
Publikationsdatum: 01.05.2011
Verlag: Springer Netherlands
Erschienen in: Medicine, Health Care and Philosophy / Ausgabe 2/2011
Print ISSN: 1386-7423
Elektronische ISSN: 1572-8633
DOI: https://doi.org/10.1007/s11019-010-9257-0

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