Physicians often express frustration with the ‘system’ in which they work. Over time, this frustration may put them at risk of burnout and disengagement, which may impact patient care. In this study, we aimed to understand the nature of the system flaws that physicians identified in their published narratives and to explore their self-representation as agents of change. We reviewed all reflective narratives published in four medical journals between January 2015 and December 2017. By consensus, we identified those that addressed (...) system flaws. Using content and narrative analysis, we analyzed the types of flaws and the physicians’ orientation to the flawed system. We identified seven recurring system flaws—five related to medical culture: failures of communication, erosive impact of the hidden curriculum, inadequate health advocacy, frenzied pace of work, and experience of stigma. Less frequently, physicians’ narratives also exposed limited and disparate healthcare resources and restrictive institutional practices as impeding patient-centered care. Physicians expressed agency to create change foremost when writing about flaws related to medical culture. While physicians are challenged by system flaws, they strive to practice in ways that do not succumb to them. We saw tension between the elements outside the physician’s control and those within it. This tension becomes a source of distress when the compromises that emerge from system flaws move physicians away from the values that define their professional identity. (shrink)

Translation of the death scene from Phaedo by Plato.

Complete translation of Plato's Euthyphro.

Complete translation of Socrates' Defense (aka Apology) by Plato.

Complete translations of Plato's Euthyphro, Socrates' Defense (aka Apology) and Crito, along with the death scene from Phaedo.

Socrates, one of the first of the great philosophers, left no written works. What survives of his thought are second-hand descriptions of his teachings and conversations—including, most famously, the accounts of his trial and execution composed by his friend, student, and philosophical successor, Plato. In _Euthyphro_, Socrates examines the concept of piety and displays his propensity for questioning Athenian authorities. Such audacity is not without consequence, and in the _Apology_ we find Socrates defending himself in court against charges of impiety (...) and corruption of the youth. _Crito_ depicts Socrates choosing to accept the resulting death sentence rather than escape Athens and avoid execution. All three dialogues are included here, as is the final scene of _Phaedo_, in which the sentence is carried out. (shrink)