Chapter V: the motivation of physicians.

• Author: Fenigsen, Richard
• Position: Other People's Lives: Reflections on Medicine, Ethics, and Euthanasia

During the twenty years of the attack on medicine that I witnessed in Holland, the media, politicians, and "people in the street" expressed the opinion that doctors' sole reason to do their work was the big money they were making. The anti-medical prophet Ivan Illich, much quoted at the time, disagreed, he knew that what motivated the doctors to work was the greed for power.

On the other extreme, the Polish school of medical ethics, and in particular one of its founders, Dr. Teodor Heiman, asserted that love of suffering mankind, and nothing else, should be the doctor's motive to practice medicine. (54) When I was a student at the Medical School, this statement by Heiman worried me a lot. Much as I tried, I could not find in my soul any genuine love of mankind, suffering or not. Further in this chapter, I shall describe what I used to feel coming to see a patient. It was quite a mixture of emotions, but love was not one of them. I had, therefore, serious doubts; perhaps I was unfit to become a doctor?

My first sobering reflections came after my first encounters with unpleasant patients. At times one comes across an obnoxious, abrasive individual, or a hostile psychopath. We certainly did not love such persons. But we paid no attention to their outbursts, and treated them the same as all other patients. If love were the doctor's motive to help patients, these people would be left without medical assistance.

Is money the incentive? I recall an elderly gentleman who on a Sunday evening fifteen times lost consciousness due to an intermittent heart blockage. Fortunately, every time he responded to a thump on the chest, and this was what I was doing waiting for the surgical team to gather. It was in the early days of pacemakers, before the invention of transvenous electrodes. Effective temporary pacemakers did not exist, and implanting a pacemaker was a huge affair; one had to open the patient's chest, cut the pericardium, and sew two button-like electrodes to the surface of the heart. In the meantime, an incision was made on the abdomen in order to implant the battery. Two thoracic surgeons (one of them the head of the department), a general surgeon, a surgical resident, and an anesthetist were working on the patient, while I was following his heart rhythm. I looked around the operating theater, and it occurred to me that if this were to be done for money, my patient wouldn't survive. I simply wouldn't be able to assemble such a team on a...