Medical Professionalism

Please start by looking at this short video:

Adherence to Ethical Principles

The University of Ottawa in 'What is Professionalism in medicine?' to which we have previously referred, discusses ethics:

"How do the ethics of professionalism differ from clinical ethics or bioethics?

The term "ethics” simply refers to a system of moral principles or standards governing conduct (9). The difference between clinical ethics, bioethics, or any other form of ethics is the subject matter to which the ethical principles pertain.

Bioethics is essentially an umbrella term for moral conduct in the broad area of life sciences and medicine (12). As described by the World Health Organization, bioethics deals with issues related to health and health care management, animal welfare, and environmental issues. It also encompasses the following subject areas: philosophy of science, biotechnology, politics, law, medicine, and theology. 

Clinical ethics tackles patient-based ethical decision-making. A subset of bioethics, clinical ethics and medical ethics are often used interchangeably. This area of ethics considers different judgments as they apply to the clinical practice of medicine. Thus, clinical ethics is a system of principles governing medical conduct with respect to patients and their families.

The ethics of professionalism in medicine is more concerned with the characteristics and behaviours of physicians in the context of medicine as a profession. Specifically, it examines desirable and undesirable attributes of physicians. Desirable behaviours include altruism, accountability, excellence, duty, honor, integrity, respect for others, and a commitment to lifelong learning. Undesirable conduct, on the other hand, includes abuse of power, bias, sexual harassment, breach of confidentiality, arrogance, greed, misrepresentation, impairment, lack of conscientiousness, and conflicts of interest.  The ethics pertaining to professionalism not only motivate patient-physician interaction, but also outline expected behaviour with other physicians, health care workers, medical students, and preceptors."

In a provocative article in the MJA, Medical professionalism: is it really under threat? Kerry Breen suggests:

• Recent publications on medical professionalism have created an impression of a medical profession under siege in several countries.

• These publications recommend a new approach to medical professionalism to assist the profession to respond to new challenges.

• I suggest that the issue is not one of failed professionalism, but a shift in the balance of the ethical responsibilities brought about by major changes in health care systems. This shift has not yet been accepted or responded to by the medical profession.

• Medical professionalism is not under threat in Australia.

• Stronger leadership is required to address this altered ethical balance in the responsibilities of doctors.

The Physicians for Human Rights website includes the AAAQ framework:  "All health-related facilities, goods and services must be available, accessible, acceptable, appropriate and of good quality (AAAQ)."

Altruism is discussed in a paper in the Journal of Primary Health Care by Ron Patterson, who defines it as follows:  

"... altruism in medicine seems to connote less the notion of gifting time and services (though volunteerism is alive and well) and more the idea of going beyond the call of duty to help patients, and perhaps also the sense of 'giving' of oneself in a consultation."

Please read the full paper, but Patterson concludes: "Most doctors recognize that professionalism (in its ancient and modern guises) calls them to a higher service than a funder, a contract, or the law may require. Finally, reciprocity is also important to sustain altruism--the ways in which society, government, and individual patients acknowledge and support the efforts of doctors. If doctors know that patients and the public continue to value the good doctor who goes the extra mile, I believe that altruism will survive."

You should also read the opposing view by Kay Baddock in the same issue of the Journal - who concludes "However, as a worker bee, we are no longer personally responsible for the patient--the system is now responsible. With that, there is a lessening of the requirement of altruism--we will not see the young doctor prepared to forgo his weekend with friends and family because a patient needs him (not the doctor or nurse who is available on call). Like the worker bee, there is always someone else there as part of the system, but that feeling of personal responsibility--which goes hand in hand with altruism--will be gone."

Special considerations must be applied in professional ethics when interacting with vulnerable populations such as patients with mental problems and substance use disorders.

This article describes the challenges in creating an ethical culture to actively support patient recovery, and a bioethics approach to treating substance use disorders. Ethical issues that arise include whether people with substance use disorders should be held responsible for their actions, their ability to give informed consent, and the acceptability of compelling patients to receive treatment. Read the content under the headings "Abstract," "Introduction," "Bioethics and Addiction," and "PCC and supportive, empathetic relationships."

Effective interaction with patients and people important to those patients 

Please see this review in the New York Times by Gillian and Sekeres: 

Can Doctors Be Taught How to Talk to Patients?

And this editorial in Archives of Medicine and Health Sciences: Humanism in Medicine: Taught or Caught?. 

Effective interaction with other people working in the health system

In the updated 2016 expert panel report: Core competencies for interprofessional collaborative practice: by the Interprofessional Education Collaborative, a number of competency statements were derived relating to communication:

"General Competency Statement-CC. Communicate with patients, families, communities, and other health professionals in a responsive and
responsible manner that supports a team approach to the maintenance of health and the treatment of disease. Specific Interprofessional Communication Competencies:
CC1. Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function.
CC2. Organize and communicate information with patients, families, and healthcare team members in a form that is understandable, avoiding discipline-specific terminology when possible.
CC3. Express one's knowledge and opinions to team members involved in patient care with confidence, clarity, and respect, working to ensure common understanding of information and treatment and care decisions.
CC4. Listen actively, and encourage ideas and opinions of other team members.
CC5. Give timely, sensitive, instructive feedback to others about their performance on the team, responding respectfully as a team member to feedback from others.
CC6. Use respectful language appropriate for a given difficult situation, crucial conversation, or interprofessional conflict.
CC7. Recognize how one's own uniqueness, including experience level, expertise, culture, power, and hierarchy within the healthcare
team, contributes to effective communication, conflict resolution, and positive interprofessional working relationships (University of Toronto, 2008).
CC8. Communicate consistently the importance of teamwork in patient-centered and community-focused care.