15 Altruism

Our Department established the Jennifer Cole International Education Endowment Fund to honor a dear colleague, who had died tragically in a cycling accident. Jennifer was the model of selfless service to others and had participated in many international medical mission trips over the course of her career. I hoped our students, trainees, and faculty would be inspired to embrace altruism as a core attribute for their careers through our Department’s global outreach efforts. This endowment would be part of Jennifer’s legacy and provide added motivation for our Department to find deserving international partners.

It was my second trip to the Korle Bu Teaching Hospital (KBTH), located in the capital city of Accra, Ghana. I had travelled to Ghana a year earlier to visit each medical school in the country in search of a future site for international rotations for Washington University medical students, anesthesiology residents and fellows, and faculty. I hoped we could find a teaching site that was interested in building a long-term collaboration focused on developing joint education programs and quality improvement initiatives. Following conversations with thought leaders in the field of global health, I was motivated to develop collaborations that would be sustainable and of mutual benefit with minimal cost or negative impact on the existing professional and cultural traditions of the host institution. An added incentive was to provide opportunities for our trainees and faculty to create programs with similarly motivated physicians from another part of the world who may not have had similar educational and professional opportunities. In other words, opportunities for each participant to “pay it forward” and do something completely altruistic to benefit other deserving colleagues.

Ghana was a particularly attractive country for our endeavor, as they were democratic and had not been impacted by a recent history of political or societal conflict. In addition, the people in Ghana spoke English, and their education and training programs were familiar and compatible with corresponding programs in the States. We selected KBTH in Accra because they appeared to have the most organized anesthesiology department in the country that provided comprehensive clinical services. They also did not have a permanent collaboration with another academic department in the States, which was surprising given their eagerness to explore a long-term relationship.

During our first day in the operating rooms at KBTH, one of the senior anesthesiology residents, Samuel, came up to me to say how excited he was to have us at their hospital. Samuel was in his final year of training and had an earnest demeanor. I immediately felt a connection. He then said, “My dream is to train at a world-class institution.” I was inspired and instantly wanted to engage this resident to find out more about him. After discussing his education and his perceived limited training opportunities in Ghana I asked, “How will you go about finding a program where you would like to train?” I was immediately remorseful asking this question as I knew I could not offer him a position at my institution given his background and inability to meet the requirements to take the credentialing exams. I was also aware how problematic it would be to assist any resident or faculty member in leaving Ghana, since it would result in the loss of yet another physician in a country desperately in need of doctors and nurses. However, I wanted to do whatever I could to support him. His sincerity and love of learning were infectious, which increased my desire to leverage both formal and unconventional connections to assist him in moving forward.

Fortunately, I had the opportunity to reach out to a colleague at a well-regarded university in Africa and submit a letter of recommendation. This was a strong letter of recommendation where I highlighted Samuel’s motivation to train at a program in Africa that could provide advanced training in anesthesiology. I was happy to learn that Samuel did in fact secure a training position at this University.

Several years later during another trip to Africa, I unexpectedly discovered Samuel working as a visiting professor at another University. I was touring the hospital and heard Samuel call out my name. We were able to chat for a bit, and I learned he was teaching an advanced airway workshop. Samuel and I promised to reconnect while I was in town, and we shared a long hug before parting. Our tour of the campus that day was followed by meetings, and the next few days passed quickly as I met with leaders at the University, exploring future collaborations. Serendipitously crossing paths with Samuel was the highlight of my whole trip, and I was saddened that we had not been able to meet again.

When I contacted Samuel to apologize for not spending time together, he insisted on driving me to the airport the next day so we could catch up. The next morning, he picked me up at my hotel. We grabbed lunch at his favorite restaurant on the way to the airport. Samuel did not stop talking about his family and his hopes for the next phase of his career. As I said farewell at the airport, I felt grateful for the few hours we had shared and to see how happy Samuel was. I asked him to keep me updated and to reach out if he ever needed anything, which he has done over the years. I am confidant Samuel will find many opportunities in his career to “pay it forward” which is all I could ask for.

An important legacy of a physician’s career and the ultimate act of altruism is their stewardship of the next generation of physicians in their field. These efforts reaffirm their own professional identity and take various forms, such as serving as a role model, providing formative career development advice and opportunities, or simply becoming a confidant and ardent supporter of a young professional’s career aspirations. There are opportunities to “pay it forward” as your career matures. A medical resident early in their career can serve as a preceptor to a more junior medical student experiencing self-doubt or struggling with the mastery of a basic skill. Empathizing with a younger colleague who is going through a challenge you have faced before is one way to contribute to your career-long legacy.

Figure 1. Benefits of altruism

A challenge for physicians when they formally retire is maintaining a connection to their profession (Figure 1). For many physicians, maintaining meaningful physician-patient relationships is the most fulfilling part of their medical career, but it is also the most challenging to replicate once they step back from clinical practice. Another important feature of a physician’s identity is the professional validation of working with peers and being part of a healthcare or research team.

A benefit of committing to an altruistic mission where you utilize your experience and skills is the satisfaction of maintaining professional continuity as you provide service in your area of expertise. Your professional identity and sense of self-efficacy are reaffirmed through your impactful contributions in your specific field. Through such contributions, you maintain the affirmative aspects of belonging to a team and organization whose values mirror your own.

A newfound altruistic mission is an opportunity to experience professional growth by expanding your knowledge and expertise in an area of interest via continuing education and new collaborations. A renewed sense of purpose is reinvigorating and gives you motivation to explore an area you did not have time to pursue during your busy career. Fulfillment is also found by reviving a previously established altruistic effort. Part of your legacy can result from dedicating your time and efforts to a new altruistic mission.

Figure 2. Opportunities to create a legacy

When physicians rediscover teaching at the end of their career, it is often transformative. Experienced clinicians and educators often are rejuvenated by the prospect of having more time to be a teacher and serve as a mentor to junior colleagues free of clinical and administrative commitments. Teaching also generates a new enthusiasm for senior physicians to expand their scientific knowledge and maintain familiarity with the latest pedagogy in medical education. I have continued to provide career counseling to former residents and fellows as well as faculty at my Institution. Contributing to the career development of physicians has been personally rewarding and kept me current with the challenges encountered by physicians early in their careers.

Seasoned physicians are well-positioned to advocate for junior colleagues. Emeritus academic physicians have the standing to lobby former colleagues and leadership for focused career development opportunities for their mentees. And more broadly, experienced physicians are uniquely qualified to advocate for better public health policies, including better access and funding for healthcare to address disparities in the delivery of medical care to disadvantaged populations. A component of this advocacy is participating in the delivery of medical care at free clinics or as a member of an emergency medical response organization on the local, national, or international level.

As I described in Chapter 12, ethical principles play a crucial role in medical care. Physicians aim to provide beneficence and ensure nonmaleficence. These ethical principles also apply to your altruistic activities. In your efforts to help others, consider the unintentional harm that could result in certain situations. The above story about Samuel would be an example of understanding the potential harm of an altruistic effort. I had concerns that my effort to help a young physician accomplish his long-term career goals might also result in the loss of a physician in a country where qualified healthcare providers were needed. I remember asking him to consider returning to Ghana at some point in his career if he left the country for more advanced training. Of course, I knew I could not make my assistance contingent on him keeping such a promise.

There has recently been a reexamination of global health outreach efforts in response to the added burden sometimes placed on international institutions that host medical students and residents from training programs in the States. Outreach efforts should be consistent with the principles of beneficence and nonmaleficence, meaning they should be collaborative with clearly identified goals and benefits for host institutions and organizations. For our international outreach efforts, we made sure to fully fund our collaborations and established that our overarching goal was to benefit the education programs and clinical practice at the host institution with initiatives that could be sustained once we left.

As a clinician, educator, or researcher, you are uniquely positioned to be an innovator and thought leader in your area of expertise. Towards the end of your career, you should have more time to explore ideas and collaborations that were not possible with a busy professional schedule. You inevitably make many connections during your career that could prove to be fulfilling partnerships in academic or nonprofit sectors.

Given the financial benefits of a long career in medicine, you may be well-positioned to become a benefactor offering financial support to organizations that share your values, such as nonprofit organizations, or providing academic scholarships to institutions that were seminal in your career, or even funding struggling programs whose survival is often dependent on the generosity of patrons.

Once established in your career, it is appropriate to “reflect forward” to envision a phase of life when you have more time to focus on areas of personal interest that provide an opportunity to remain connected to your profession and create your legacy.