A Moral Compass: Dr. Howard Bauchner, University of Texas Health Science Center McGovern School of Medicine at Houston

Abstract

This week’s commencement speech is by Dr. Howard Bauchner, who spoke at the University of Texas McGovern School of Medicine in Houston, TX. Howard Bauchner, MD was appointed the 16th Editor in Chief of JAMA® and The JAMA Network® in 2011. Prior to coming to JAMA, Howard was a Professor of Pediatrics and Public Health at Boston University School of Medicine and Editor in Chief of Archives of Disease in Childhood (2003-2011).

Dr. Bauchner focuses his speech on the morality of being a physician and ethical challenges one must face. He starts by emphasizing the trust patients will place on the graduating medical students: “What I want to focus on is the need to find a moral compass in your life as a physician. I cherish being a physician. Many patients trust us with their lives – thankfully we are no longer seen as a gods – and that is a good thing – but many many patients want us to help them with some of the most difficult and emotional decisions in their lives – how to care for a sick child, how to help a failing parent, what test or procedure should they have for themselves, and of course among the most difficult decisions – care at the end of life. This is your future as a physician, embrace it – and feel the privilege that it is to be so intimately involved in the life of another individual.â€

He discusses the ongoing ethical issues facing the medical community such as high healthcare and drug costs, special interest groups that place the wellbeing of patients second, and difficulty of decision-making at the individual level vs the population level. He tells the graduates that they will have to face new ethical challenges with the advancement of technology, and must play the role of patient advocate.

To demonstrate the difficulty of managing such ethical issues, Dr. Bauchner shares a personal story of struggle: “I want to tell you a story of my own ethical failing - one that has haunted to me to this day.  I was attending on the wards at BMC – the old Boston City Hospital – and after days of caring for a child with pneumonia who was not getting better, and me resisting the idea of a repeat CxR, the child developed sepsis.  I was notified in the early morning hours at home, his temperature was 104, his WBC had increased to 35K, and a repeat chest CxR showed a large pleural effusion – likely an empyema.  He was whisked off to surgery, the effusion was drained, he was intubated, started on pressors for hypotension, and broad-spectrum antibiotics to cover the suspected bacteria.  I arrived the next morning – immediately went to the ICU – by this time his BP had stabilized, he had responded to the antibiotics, and was about to be extubated.  His parents came up to me and profusely thanked me for saving their child’s life – I stumbled – mentally and vocally – what should I say.  And to this day I feel ashamed, ashamed that I did not say what I should have, but you do not understand – it was my decisions that made your child so sick.

You will face many decisions – perhaps not quite as dramatic as this – that will affect your lives and the lives of your patients.  When do you speak up and when do you remain silent.  The colleague who does too many tests; the health care system that purchases practices so they can charge higher prices for care; the insurance company that blocks appropriate care; the pharmaceutical and device industries that charge prices in the US that are 5 and sometimes 10 times more than anywhere else in the world; and most importantly end of life decisions that you will make with patients and will be influenced by your own religious, cultural, and personal experiences.  You are likely to confront some but not all of these issue next year as a first year resident, but most will find their way into your professional life at some time.  There is no need to wrestle with all of them, since that can be overwhelming, but it is important to understand that these are ethical issues that demand and require much thought and reflection.â€