The Virtuous Physician vs. The Virtuous Nurse

D. John Doyle MD PhD

April 2004

djdoyle@hotmail.com

What characteristics would you list, and why, for a virtuous physician; a virtuous nurse? Explain why you think their characteristics are the same or different. These questions are addressed in this essay.

"Virtue is harder to be got than a knowledge of the world; and, if lost in a young man, is seldom recovered."  John Locke

“Wisdom is knowing what to do next; virtue is doing it.”  David Star Jordan

According to the Internet Encyclopedia of Philosophy [1] “virtue theory is the view that the foundation of morality is the development of good character traits, or virtues”. According to this model, a person is good or virtuous to the extent that he or she has virtues and lacks vices.  Another way of looking at the matter is to state that there are certain ideals, such as the pursuit of excellence or dedication to the common good, which we should strive for and which permit the full development of our humanity. Virtues may be viewed as attitudes or character traits that enable us to develop this potential.

The virtues of everyday life include generosity, fidelity, self-control, honesty, truthfulness, integrity, bravery, courage, justice, patience, prudence, fortitude, tolerance, and countless others. In fact, some virtue theorists have identified over 100 virtuous character traits.

However, different social groups may emphasize different “virtue sets”. For instance, the Boy Scout virtues are “trustworthy, loyal, helpful, friendly, courteous, kind, obedient, cheerful, thrifty, brave, clean and reverend” [2]. By contrast, some other social groups (Satanists and Hell’s Angels members come to mind) would not consider all of these character traits to be virtuous [3].  Indeed one man’s virtue may be another man’s vice, as in the often-used term “generous to a fault”.

Minogue details five virtues that are associated with medicine [4]. He holds these to be:

1.Compassion

2.Courage

3.Tolerance

4.Honesty

5.Faithfulness  (or Fidelity, or Loyalty)

Missing in this list is a trait that most patients want above all in a physician or nurse – competence. The importance of professional competence as a virtue has been emphasized elsewhere.  For instance, the College of Human Medicine at Michigan State University has developed a set of “desirable professional attributes” that are used as examples of “professional virtue” for guiding medical students [5]. These attributes fall into six categories:

1. Competence

2. Honesty

3. Compassion

4. Respect for Others

5. Professional Responsibility

6. Social Responsibility

While there is considerable overlap in these lists (for instance, both lists include compassion and honestly as desirable traits, and Minogue’s “tolerance” trait is similar to the “respect for others” trait in the College of Human Medicine list), the differences are nonetheless striking. Also, I do not regard “courage” as an especially important trait in clinical practice, except in the context that exercising honesty and responsibility in hostile settings can sometimes require considerable courage. I would argue that both these lists should be combined to make a list of virtues for physicians. The combined list I would then propose would be:

1. Competence

2. Honesty

3. Compassion

4. Respect for Others

5. Professional Responsibility

6. Social Responsibility

7. Courage

8. Loyalty

Yet it is also appropriate to consider even more virtues that might apply, such as resourcefulness, patience, integrity, wisdom and prudence. To the extent that these traits overlap with the list above it is not necessary to explicitly list them.  Still, I feel that they are important clinical virtues.

One interesting issue is whether the traits of the virtuous physician and the traits of the virtuous nurse are similar. I would argue that they are indeed similar, that there are no more differences between the traits of the virtuous physician and the traits of the virtuous nurse then there are between the virtuous traits of the various medical specialties. There are, of course, differences between what nurses and physician do, just as there are differences between the various medical specialties do. But I do not believe that these differences are so great that different sets of virtues are necessarily implied. Both groups have the same goals in mind for their patient, and both groups share a similar clinical worldview. The fact that one group frequently implements orders from the other is not, in my view, an overriding issue. Nor do I regard it as particularly relevant that nurses are often said to come from a tradition of caring, while physicians are often said to come from a tradition of science and reason. The reality is that both traditions are major influences on both nurses and physicians in today’s clinical world.

Notes

[1] http://www.utm.edu/research/iep/

[2] More information is available at http://www.scouting.org

[3] More information is available at http://www.churchofsatan.com

[4] Source: http://www.acsu.buffalo.edu/~fescobar/337H/lecture10.htm

[5] More information is available at http://www.chm.msu.edu/chmhome/index.htm