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LEARNING OBJECTIVES

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  1. To conceptualize “professionalism” in terms of behaviors.

  2. To define the roles of physicians, teams, healthcare systems, and the external environment in supporting professionalism.

  3. To explain the role of physicians in influencing both the microsystem and the broader environment to enhance professionalism.

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INTRODUCTION

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Dr. Jackson is a 2nd-year medical resident doing a rotation on the wards of a teaching hospital. He was entering an order for an angiotensin-converting enzyme (ACE) inhibitor for Mrs. Shaw, an 80-year-old patient with congestive heart failure, when the chief resident interrupted him to discuss Mrs. Fraser, a patient with asthma who needed additional bronchodilator treatment. When Dr. Jackson returned to the computer, he incorrectly entered the order for salbutamol into the chart of Mrs. Shaw. The nurse noticed that this was a medication that had not previously been prescribed for Mrs. Shaw but did not question the order. The next day, the nurse sees Dr. Jackson during ward rounds and asks why the team started the salbutamol on Mrs. Shaw. When they realize there has been a medication error, the nurse and resident feel uncertain about whether they should tell the patient because she has not suffered any physical problems from the wrong drug. If they tell her, how should they do this and who should share the information with her? How might this be prevented in the hospital in the future? Dr. Jackson remembers he attended a lecture that mentioned that the hospital has an office that helps physicians with disclosing medical errors.

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This case of a medication error illustrates a common occurrence and one in which multiple healthcare professionals play a role. Disclosing the error to the patient is a professional responsibility for the entire healthcare team. Dr. Jackson and the nurse will meet to plan how to tell Mrs. Shaw what occurred. The hospital has staff members who are experts in disclosing errors who will help Dr. Jackson and the nurse to prepare for this challenging disclosure conversation. Staff in the hospital’s quality improvement department will conduct an analysis of the error to see how this error occurred and how they can prevent similar mistakes in the future. The hospital prides itself on compliance with the external standards set by the Joint Commission and the National Quality Forum Safe Practices regarding disclosing errors.

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A medical error like this one is a challenge to our professionalism. Nobody working in healthcare intends to make a mistake, and yet, they occur routinely despite our best efforts to prevent them. Disclosing the error is a difficult task, but undertaking that conversation with the patient is an indication of the professionalism of each part of the system—the physician, the nurse, residents, medical students, and the hospital administration. Each player in the system, from an individual physician to the healthcare system itself, can demonstrate a high level of professionalism through behaviors that support the disclosure to the ...

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