Medical Professionalism

Resources: Introduction and definitions

Before starting to read the resources and text listed below, please take a look at this short video from the Topic tutors: 

As we start this course on Medical Professionalism, it might be a good idea to define what we mean by the term. Below are four consistent, but differing, definitions.

• "Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served." [Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA.2002;287(2):226-235].
• "Professionalism embodies the relationship between medicine and society as it forms the basis of patient-physician trust. It attempts to make tangible certain attitudes, behaviours, and characteristics that are desirable among the medical profession." [University of Ottawa: What is Professionalism in Medicine?]

• "Medical professionalism is the basis of medicine's contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health." [Physicians for Human Rights: What is medical professionalism?]

• The Kings Fund report 'On being a doctor: Redefining medical professionalism for better patient care' defines 'modern professionalism' as "The first duty of a doctor must be to ensure the well being of patients and to protect them from harm - this responsibility lies at the heart of medical professionalism. Patients expect doctors to be technically competent, open and honest, and to show them respect. By demonstrating these qualities, doctors earn the trust that makes their professional status and privileges possible. In the absence of a single, widely accepted definition of professionalism, we have drawn upon the work of Irvine (Irvine 2003) and others (Cruess R, Cruess S 2003; Medical Professionalism Project 2002) to suggest that the concept has four basic characteristics. These are:

• a calling or vocation linked to public service and altruistic behaviour
• the observance of explicit standards and ethical codes
• the ability to apply a body of specialist knowledge and skills
• a high degree of self-regulation over professional membership and the content and organisation of work."

Sylvia and Richard Cruess, in a paper "Professionalism must be taught" (or you can get the full pdf through this link) distinguish between the 'healer' and the 'professional;' roles of doctors: "Doctors are judged both as healers and as profession­als, and when they do not fulfill their obligations in either role both they and the profession suffer." They also frame professionalism as a contract between society and the profession - and as such, a contract that could get broken. Their paper is summarised as: 

• Professional status is not an inherent right, but is granted by society
• Its maintenance depends on the public's belief that professionals are trustworthy
• To remain trustworthy, professionals must meet the obligations expected by society
• The substance of professionalism should be taught at all levels of medical education as part of the profession's response to changing societal expectations

As mentioned in the Introduction, the Australian Medical Association has a definition which concludes: 

"The AMA believes that by adhering to the core values and professional commitments of medical professionalism, doctors can meet the challenges of a rapidly changing health care environment and continue to ensure that patients are their primary interest and that patients and patient care remain central to the health care system."

Introductory resources.

The ABIM Foundation has a video - Why does Professionalism matter? - it is a good introduction to the course.

There is also an excellent slide show called Professionalism from the Science Supercourse: pdf file here. By Richard C Frederick, Society for Academic Emergency Medicine.