Box 1.

The use of this approach in professional reflection

Doctors face different clinical and professional situations on which they need to reflect. In this box we consider as an example one clinical situation and how this framework might be used. However, this can be readily adapted for different disciplines and settings.
An oncologist's patient is diagnosed with stage 4 metastatic cancer. There are no treatment options that result in medium- or long-term benefit. However, the patient wants to have the ‘latest’ therapy.
How might I achieve my purpose as a medical professional?
The doctor might reflect on what they do in light of their purpose and check that they are working to that purpose, rather than some secondary or false purpose.
  • What does ‘health’ and ‘flourishing’ mean for me and, more importantly, for this patient? In this example this might involve considering whether health is about a full life or a long life.

  • Am I working to enable this patient to achieve the best health possible, or am I chasing some other goal (such as self-esteem, reputation, or avoiding distress)?

  • Is there a better way to achieve this purpose than the approach I am taking?

  • Am I being the best doctor possible for this patient?

How can I exercise my virtues appropriately?
The medical professional could look at the four virtues of courage, temperance, justice and wisdom, and reflect on what they can mean in this situation, and whether they are exercising them appropriately (at the right time, in the right way and to the right extent).
  • Am I being appropriately courageous when I am having conversations with the patient, their family and other clinicians involved in their care? In this case, a courageous conversation would be discussing the reality of the situation (from both the doctor's and patient's point of view), rather than avoiding distress.

  • Am I using the available resources (time and money) in a way that is just? For example, it would not be just to use an expensive treatment that is known to be ineffective simply because the patient ‘wants something’.

  • Am I considering the patient's (and others, including the care team's) needs and wants? These may not be clinical needs, but include the need to be treated in a compassionate and dignified manner. This may require the doctor to spend time helping the patient understand and articulate their needs.

  • Am I in control of my emotions, desires and wants so that I am not doing things for the wrong reasons including for my own sake? A doctor might inappropriately promote a treatment option because it boosts their self-esteem and makes them feel capable of helping a patient in a difficult setting, rather than for any true benefit.

  • How am I using my wisdom to know when and how to exercise virtues and skills? The doctor is like musical conductor, bringing in skills and virtues at the right time and volume.

What other virtues should I be considering?
The classical list of four virtues can be supplemented by other character traits. The professional could reflect on whether there are others that they understand important for their professional behaviour. As discussed in the main text, clinical curiosity could be considered important.
  • Have I considered all aspects of this patient's condition and situation that might be relevant? Is there something unusual about the pathology, or does knowing more about their beliefs and values, help me achieve my purpose?

  • Is there knowledge (in the literature, or from a colleague) that I could find out that would help me?

Am I using my skills appropriately?
One of the roles of wisdom is to help the medical professional use their skills appropriately.
  • Am I using my training and skills to enable my patient to achieve as good a health as possible?

  • Should I have used a different approach in this situation?

  • What skills do I need to develop to improve my ability to be a good doctor for this (and future) patient?

Am I getting fulfilment as a doctor?
This question can be more relevant when a doctor is reflecting on their overall professional development, rather than a particular clinical situation. However, reflection on what fulfilment is achieved in a particular situation can be important in motivation and maintaining a sense of purpose.
  • What is it that I love about being a doctor?

  • What did I do well as a doctor in this setting?

  • Am I too focused on external goods (money, reputation etc.) that I have lost sight of the potential joy and fulfilment I can get from being a doctor?