‘As Physicians, We Owe Our Patients Two Things—Only Two Things—Our Time and Our Skill. We Do Not Owe Our Patients Our Lives.’ — Joseph D. Wassersug, MD (1912-2011)
Editor-In-Chief, Chester “Trip” Buckenmaier III, MD, COL (ret.), MC, USA
My wife and I have had the good fortune to spend the United States’ semiquincentennial (July 4, 2026), the 250th anniversary of the Declaration of Independence of the 13 United States of America, with a rare gathering of our entire clan at the Maine family camp. Like many Americans, I have used this landmark July 4 celebration to reflect on myriad positive aspects of being born and raised in this country. Of late, the 24-hour news deluge of graft, corruption, war and disaster that consumes American media can challenge the patriotism of the most ardent United States citizen. For most of my life, despite this society’s 250-year struggle to live up to the aspirations outlined in the Declaration of Independence, I have taken for granted the American ethos of equality and force for world virtue. Service to our constitutional republic has been a family business for five generations. Regardless of personal politics, America’s leadership position as a positive influence on world affairs has suffered of late.
For me, it has been harder to wear the label of American than ever before. In conversations with friends, colleagues and new acquaintances, I have discovered that many are wrestling with the existential question of what it means to be an American. Fascinatingly, I have had this same feeling in my past when I was confronted with the pragmatic question of what it means to be a physician. In some respects, the identity challenge many Americans are experiencing during this turbulent time in our history mimics the anxiety endured by newly minted physicians. Weaving the physician identity and the awesome social responsibility inherent to the persona into a successful personal life is a collective experience all physicians can relate to.
While preparing this opinion piece, I came across a quote regarding physicians from Dr. Martin Fischer, a German-born American physician who influenced generations of medical students with his aphorisms, known as “Fischerisms”. Fischer famously said, “A doctor must work 18 hours a day and seven days a week. If you cannot console yourself to this, get out of the profession.” This quote stopped me cold and dredged up gobs of unwelcome experiences I engaged in as a training clinician. I had never heard Fischer’s comment before, although versions of the sentiment inundated my formative clinical years. I even had one senior staff physician liken resident surgical training to “going to war.” Well, I have been to war, and the two experiences have little, if anything, in common.
It was, indeed, a titanic struggle to balance my personal need to be a respected physician with my responsibility to be a good husband, father and friend. Fortunately, I was blessed with a spouse and several physician mentors who categorically rejected Fischer’s standard for doctors. Throughout my career, I have encountered physicians who have adopted the martyr’s approach to the medical profession. I will even admit a grudging respect for that level of commitment, but I recoil at the price it exacts from the individual and those in their orbit. The best clinicians and officers I have trained under certainly understood the necessity of a balance between personal life and medicine.
I believe fanatic devotion to anything, whether in the medical profession or in being an American, is unhealthy for the individual and the institutions they serve. There are aspects of physician training, as there are with being an American, that are flawed. Perfection will be found neither in the profession of medicine nor in the politics of our republic. There is always room for improvement in any human construct, but that revitalization can only occur when imperfections are honestly assessed and avowed.
The time I have invested in sailing with my wife, fly fishing with my daughter or playing blocks on the floor with my grandson is just as consequential in my ongoing development as a good physician as my endless hours in the hospital ever were. Likewise, the time I have spent protesting injustice and corruption in our government is just as valuable in enhancing my American citizenship credentials as my time in federal service to our Constitution ever was. In medicine, as in citizenship, the ability to be critical of the profession or country you love and to occasionally seek refuge from institutional demands is a healthy response that can only strengthen the profession and the country.
We certainly owe our patients a considerable portion of our time and expertise. Devotion to the practice of medicine is not only laudable but required. That devotion should not be at the expense of family, friends and personal pursuits that give life meaning. The best physicians understand this concept and successfully maintain a work-life balance. I also believe that the best American citizens over the past 250 years understood that patriotism does not mean absolute devotion, as embodied in the slogan “My country, right or wrong.” Rather, good citizens take pride in America’s history of exceptionalism, while still facing its often painful and ugly failures. I can love medicine and spend a successful career criticizing and improving its flawed conventions. I can love our republic and still criticize its flawed institutions and work to improve them. Being a good physician, like being a good American, demands balance.