What is a Hero in Medicine?
H. Steven Moffic, MD
Some years back, I and a few other psychiatrists were given a one-time award by the American Psychiatric Association for being “Heroes of Public Psychiatry.” “Who, me!?” After I got through the shock and surprise, I accepted the award, though something was uncomfortable about it. I had never thought about being a hero. Heroes to me were those who dramatically put their life at risk to save people in danger. Me? I suppose that could have happened to me, say disarming a patient about to shoot someone else or him/herself, but I never had to do that. I had just been doing the best I could year by year as part of a system trying to help the poor and underserved with mental health problems.
In commenting on behalf of us in accepting the award at a ceremony, my fellow psychiatrist said that the patients were the real heroes, not us. Again, I felt a bit uneasy. Could they be considered heroes just because they had to cope with their mental illness, as hard as that might be?
From my perspective, if I ever thought there were heroes in medicine, it was physicians in other specialties, especially some surgeons and/or emergency room physicians. Not only did they have skills that I never had, but they could produce dramatic cures or medical breakthroughs that I could never imagine happening in psychiatry for now. About the only psychiatrist I could consider to be a real hero was Robert Jay Lifton, a Jew who went to Germany to interview Nazi doctors and was thrown in jail for protesting the Vietnam War as part of a career in researching, confronting, and responding to the manifestations and ramifications of what he deems is evil.
So, what then, if anything, is a hero in medicine? Is it certain kinds of physicians, patients, the team, really no one, or potentially everyone involved?
To attempt to answer this question, perhaps we have to look to who are considered heroes in society and what possibly goes into making a hero. After all, it is clear throughout history and literature that we humans have a deep and understandable psychological need for heroes in a world of acute and chronic danger to our vulnerable selves.
The most well-known writer on heroism is Joseph Campbell, as exemplified best in one of his many books, The Hero With a Thousand Faces. More than just describing mythical heroes, he describes the heroic journey. This journey includes:
- an acute or chronic high-risk danger;
- a willingness, sometimes after a brief hesitancy, to heed the call and calling to respond;
- a guide or mentor to help;
- venturing into the unknown;
- responding to tests and temptations;
- discovering who you are in the deepest sense, including what you are best at;
- and then returning to everyday life.
Historically, such leaders as Abraham Lincoln, Gandhi, and Martin Luther King have been viewed as heroes who went on lifelong heroic journeys. They knew their life could be in danger, and indeed they were all eventually assassinated. Many more everyday people are considered heroes for responding to a one-time only crisis, like saving people in a burning building, being a first responder on 9/11, or saving one’s fellow soldiers in a firefight. In the realm of fiction, such heroic journeys are portrayed in movies, in particular the Star Wars films by George Lucas.
It is rare, if not ever, that you find someone who sets out deliberately to become a hero and then is considered one by society. Being considered a hero seems to be a byproduct of other values and actions in the right circumstances.
Not surprisingly, such theories as those of Joseph Campbell have been criticized, leading to psychological and social research on the topic. It has not been easy to discover verifiable answers, though much of what Campbell hypothesized seems to have merit.
The psychologist Frank Farley concluded that heroism was really on a spectrum, going from the dramatic and dangerous acts of heroism that we often think of, but also extending to everyday heroism, where helping others is usually not connected to the significant risk of serious harm. Heroes, according to Farley, are likely to have the personal characteristics of generosity, courage, and altruism. The situations they find themselves in then allow those traits to translate into acts of heroism.
In so many ways, and in line with Campbell’s portraits, medicine offers an ideal environment for heroism of all kinds. Patient’s lives and health are at stake, sometimes acutely like in emergency medicine, and sometimes more chronically and delayed. There needs to be a willingness and desire to confront the challenges of patients' needs. One needs teachers, guides, guides, and mentors. Demands infringe on personal times and loved ones. Temptations must be ignored and tests must be passed. Over time, to be at your best, medical healers must connect with a deep desire to connect with and care for the patient, and then be able to put that into action.
Although such heroism can reside in individual physicians, in our age of increasingly complexities in care, it often has to reside in a team and in an organization that will set up a setting that will allow the team to thrive. In the Harvard Business Review interview, Atul Gawande said that “health care needs a new kind of hero.” He illustrated this point by discussing Sully Sullenberger, the pilot who landed the endangered plane on the Hudson River. The public tended to view him as it tends to view doctors, and that doctors often want to view themselves, as a lone hero. However, Sullenberger kept saying no, that it was adherence to protocol and teamwork that allowed the plane to land safely. Similarly, in medicine it is teamwork that can so often provide the best care.
A hero in medicine, then, I would consider to be both much more and much less than the traditional image of a hero. It is an individual, team, or organization of caregivers that through a healing relationship and skillful application of the tools of healing puts the needs of patients right in front of you first, even if that is at risk to other personal or organizational needs. How often that really happens is yet to be known.
Perhaps what the tennis star and breaker of racial barriers, Arthur Ashe, once said gets the closest to what is a hero in medicine:
“True heroism is remarkably sober, very undramatic. It is not the urge to surpass all others at whatever cost, but the urge to serve others at whatever cost.”
H. Steven Moffic, MD
Lead blogger for Psychiatric Times, Behavioral Healthcare, and the Hastings Center “Over 65”
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