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  • Field Notes
  • Richard Payne (bio)

Valuing Clinical Excellence in End-of-Life Care. Last year, The Hastings Center and The Cunniff-Dixon Foundation launched an important new award program—the first of its kind—honoring four physicians who have excelled in providing care for patients at the end of life. The awards focus on physicians because The Cunniff-Dixon Foundation rightly recognized that care at the end of life “has long troubled American medicine, not only in its failure to provide good palliative care, but also in the relationship of doctors and patients.” The awards committee, which I chaired and which was supported by the Duke Institute on Care at the End of Life, considered more than one hundred and forty nominations.

The four awardees exemplified excellence in medical practice in a wide range of specialties including surgery, pediatrics, internal medicine, and palliative care. The criteria for the awards included outstanding technical competence in the field, exceptional personal integrity, superior communication skills, practices that engage the patient as part of a network of family and friends, and practice and leadership within an effective clinical team. I suspect that the new Hastings Center Cunniff-Dixon Physician Awards have already gained traction because they fill an important void, allowing us to acknowledge and value excellence in the clinical arena of end-of-life care. But the awards are significant not just because honoring the accomplishments of exemplary physicians is important, but because doing so illuminates the best in the profession, providing true role models for current and future generations of doctors.

The idea of role models is old fashioned but still relevant, particularly for doctors navigating the contemporary challenges of medical practice today. Aristotle believed that one became a virtuous person by modeling the behavior of moral people, and in so doing embedding the habits of ethical, moral, and (I might add) professional behavior. The complexity of diagnostic and therapeutic thinking required in today’s fast-moving, scientifically driven world of medicine increases seemingly logarithmically. In addition, all doctors must confront obvious and sometimes insidiously subtle conflicts of interest born of the complicated networks of relationship with insurers, industry sponsors, and a myriad of individual personal and professional ambitions. Doctors must therefore be constantly attentive if they are to act in the best interest of the patient and be trustworthy in fulfilling critical commitments to care at the end of life—attending to pain and suffering, nonabandonment, and communicating with patients and families in ways that truly enable informed decision-making and uphold personal autonomy. The first cohorts of physician awardees performed these essential qualities of professionalism at the highest levels, and they inspire all physicians, novice and experienced, to practice habits that live up to the standard they have set.

The 2011 awards process is now under way. The deadline for nominations is September 30, and information about submitting nominations is available on The Hastings Center’s Web site. [End Page c3]

Richard Payne
Esther Colliflower Director
Duke Institute on Care at the End of Life
Richard Payne

Richard Payne is professor of medicine and divinity at Duke University and the Esther Colliflower Director of the Duke Institute on Care at the End of Life. He is board certified in neurology and palliative medicine.

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