Teach, Advocate, and Return Phone Calls: A Path to Personal Development

Do you consider professional ethics as nothing but a set of rules involving our conduct with patients? Follow the rules and you’ll stay out of trouble? In truth, the philosophers who evolved concepts of personal and professional ethics were less concerned with rules than they were with social justice, personal well-being, and refining the life of the mind. If we contemplate what it means to be ethical psychiatrists, we may consider not only our behavior with patients and colleagues, but also our demeanor in all aspects of our lives. We may advance our experience of professional ethics in myriad ways, including teaching, affecting public policy, or even extending polite courtesy to strangers.

In the fourth century BCE, Hippocrates instructed physicians to practice professional ethics and gave this reason: “To preserve the purity of my life and my art.” In addition to prescribing regimens “for the good of my patients according to my ability and my judgment,” he also vowed to teach students the art of medicine “without fee or written promise.”

In Hippocrates’ time, physicians taught only the sons of physicians for free. In contemporary society, there are many more ways to discharge our duty to educate. Teaching medical students, residents, fellows, colleagues, and health care providers from other disciplines through lectures or supervision remains a valuable and honorable activity. Educating our patients, their families, and the public is a newer way to pass on the gift of medical knowledge.

Freely transmitting our knowledge is not the only avenue to enhance our experience as ethical individuals. The 17th-century German philosopher Gottfried Liebniz envisioned a “society united to serve goals of justice and charity that transcend self-interest.” He would have approved of California’s Proposition 63, which in 2004 established a 1 percent tax on all personal incomes over $1 million to fund new mental health programs. Unfortunately, although this program has generated millions of dollars and funded an array of prevention programs, it has not necessarily benefitted those with chronic mental illness. While the program achieves the goal of charity, it may be falling short of justice by allocating resources to the worried well rather than the seriously ill. This failure should not cause us to give up, but should inspire mental health activists and advocates to further efforts to affect public policy toward a more effective mental health care system.

A Dutch contemporary of Liebniz, Baruch de Spinoza, established three “rules of living” to assist individuals in their pursuit of mindful happiness. The first rule is to get along with the rest of humanity, that is, to follow accepted social customs and behave amicably with all other people. By following simple courtesies, such as returning phone calls from prospective patients even when our practices are full and helpfully offering a few referral suggestions, we promote the well-being of the public. Spinoza would add that by spending a few minutes in this courtesy, especially because there is no financial profit, we advance our personal development. Indeed, in addition to advancing personal development, this simple courtesy advances our profession’s image. How confusing and hurtful must it be to an individual seeking psychiatric care to leave messages for psychiatrists and receive no returned calls. This silence may communicate more than lack of courtesy; it may suggest indifference or disrespect, tainting our profession’s public image. In contrast, taking five minutes to return the call, even if we don’t accept the patient into our practice, presents the profession as humane and committed to trying to help.

The truly ethical psychiatrist, the ethical human being, looks beyond mere rules and examines his or her own values to further individual development and refine the life of the mind. We need not all teach. Nor need we all become involved in public policy. I do believe we should be polite to everyone we encounter, although we may differ in our ideas about courtesy’s extent. As each of us strives to reach our intellectual, humanistic, and spiritual ideals, our contemplation of ethics helps inform our growth. Out of such contemplation, a personal plan to advance ethics will emerge. ■