As a fifth-grade student, I was introduced to Japanese culture through a school program. I lived in Japan on an American military base from 1967 to 1970. I remember learning about tea ceremonies, calligraphy, and the samurai code known as Bushido.
At the time, I understood very little of it. What I remembered was the idea that a person should strive to become the best version of himself every day. Not perfect. Better. Only decades later did I realize how deeply that lesson had shaped my life as a physician.
Today, many Americans hear the word Bushido and think of wartime Japan, kamikaze pilots, and fanatical loyalty to the emperor. That is not the Bushido that first captured my imagination.
The Bushido that influenced me was closer to the philosophy described by Inazo Nitobe in Bushido: The Soul of Japan and illustrated in the film The Last Samurai. It emphasized integrity, courage, compassion, respect, sincerity, honor, and loyalty.
Real physician voices, twice a week
Free, and one click to unsubscribe.
Most importantly, it emphasized mastery. Not mastery over others. Mastery over oneself. Medicine once embraced many of the same ideals.
Unfortunately, modern medicine increasingly measures productivity rather than character. We count relative value units (RVUs), patient encounters, quality metrics, publications, grants, and administrative accomplishments. Those measurements have value, but they tell us very little about whether we are becoming better physicians or better people. The seven virtues of Bushido offer a different standard.
Gi (rectitude)
Rectitude means doing the right thing because it is right. Every physician encounters situations where honesty is uncomfortable, inconvenient, or even costly. It may involve admitting uncertainty to a family, reporting an error, or challenging a policy that harms patients.
Rectitude asks a simple question: What is the right thing to do? Then it demands an answer.
Yu (courage)
Courage is often misunderstood. Most physicians will never face a battlefield. Many will, however, face situations requiring moral courage.
The courage to challenge a powerful administrator. The courage to advocate for a patient against an insurance company. The courage to speak honestly when silence would be safer.
Bushido did not define courage as recklessness. It defined courage as intelligent action in the face of fear.
Jin (compassion)
Compassion is the foundation of medicine. Knowledge without compassion becomes arrogance. Authority without compassion becomes cruelty.
The developmental-behavioral pediatricians, family practitioners, nurses, therapists, and countless others I have admired throughout my career shared one characteristic: They genuinely cared about the people they served. Bushido recognized that strength confers responsibility. So does medical knowledge.
Rei (respect)
Respect has become an increasingly scarce commodity. Patients often feel unheard. Physicians often feel undervalued. Health care workers throughout the system frequently feel invisible.
Bushido teaches that courtesy and respect are not signs of weakness. They are signs of discipline.
The child with autism deserves respect. The exhausted parent deserves respect. The receptionist deserves respect. The janitor deserves respect. The specialist and the primary care physician deserve respect. Civilization depends upon such ordinary acts.
Makoto (sincerity)
A samurai’s word was expected to mean something. So should a physician’s.
When we promise to call a family, we should call. When we say we will review a study, we should review it. When we admit that we do not know an answer, we should mean it.
Trust remains medicine’s most valuable currency. And trust is built through sincerity.
Meiyo (honor)
Modern culture often confuses honor with reputation. They are not the same. Reputation is what others think about us. Honor is what we know about ourselves.
A physician can accumulate titles, awards, publications, and prestige while losing honor. Conversely, a physician can hold his head high despite professional setbacks because he has remained faithful to his principles.
Honor comes from accountability. It comes from living in a manner consistent with one’s values.
Chugi (loyalty)
The final Bushido virtue is loyalty. Again, this is frequently misunderstood.
For physicians, loyalty should never mean blind obedience to institutions. Our highest loyalty must be to patients, families, ethical principles, and truth itself.
Organizations change. Policies change. Administrators change. Principles endure.
When I look back at my career, I realize that I have been trying, imperfectly, to follow these virtues for a very long time. Not because I consciously adopted Bushido as a life philosophy. Rather, because something about it resonated with me when I was a child.
The best physicians I have known embodied many of these ideals. So did many military officers.
Recently, while cleaning my office, I discovered the final letter my father wrote to my mother less than a month before he was killed in an Air Force aircraft accident in 1970. The letter was not dramatic. He wrote about flight hours, requalification, training, and future assignments.
Reading it, I was struck by how much of life is revealed through ordinary responsibilities performed well. My father was not trying to become a hero. He was simply trying to be competent. The same could be said of astronauts Neil Armstrong, Buzz Aldrin, Gordon Cooper, and countless physicians I have known throughout the years.
Bushido is often associated with how people die. I think that misses the point. The Bushido that inspired me was never about dying. It was about living. It was about approaching every task, whether flying an airplane, caring for a patient, writing an article, raising a child, or helping a stranger, with discipline, integrity, and respect.
One of my favorite lines from The Last Samurai occurs near the end of the film. A character tells Emperor Meiji, when he asks how Lord Katsumoto Moritsugu died, “I will tell you how he lived.”
That, ultimately, is the lesson. Not how we die. How we live. And how faithfully we pursue excellence while we are here.
Ronald L. Lindsay is a retired developmental-behavioral pediatrician whose career spanned military medicine, academic leadership, and national advocacy for dignity-centered neurodevelopmental care. His NIH-funded work with the RUPP Autism Network helped define evidence-based approaches to autism and related developmental disorders.
He directed the LEND Program at The Ohio State University and founded JBLM CARES, a $10 million autism resource center for military families. His writing spans clinical scholarship and long-form fiction. He is the author of The Mercy Directive and the six-novel Cassandra series, a completed political and medical fiction saga tracing the rise of the Cassandra system from its origins to its national and international legacy. His forthcoming memoir, The Quiet Architect, examines how conscience and structure collide in modern medicine.
He shares updates on LinkedIn.
