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LEARNING OBJECTIVES

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  1. To articulate the importance of evaluating professionalism.

  2. To describe the challenges involved when evaluating professionalism.

  3. To review common instruments used for evaluating professionalism.

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INTRODUCTION

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Lucy, a 4th-year medical student, is walking down the hall with her attending surgeon, Dr. Wong, at the end of their inpatient ward rounds. Lucy tells Dr. Wong that the patient they are about to see wants to know the results of her latest tests. The patient is a few days post-liver transplant, and on a postoperative film they discovered a large lung mass that was not noticed preoperatively, and no one has told the patient. Every day the patient asks about any new test results, and Lucy feels awkward not telling her. Dr. Wong tells Lucy that it is up to the medical team and not up to them, as they are just responsible for the surgery and postoperative care. Just then, Dr. Wong gets paged away to the operating room, and Lucy enters the patient's room on her own. The patient is in good spirits, and wants to go home soon. She asks Lucy, “What do my tests show?”(Ginsburg, Regehr, & Lingard, 2003).

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What should Lucy do? Her basic options are “tell” and “don't tell,” but clearly it is more complicated than that. Let's assume Lucy has just been to a lecture on the importance of honesty and full disclosure with patients, and decides to “be honest” and tell the patient about the x-ray finding. What would happen next? The patient would be fully informed about her condition, which was the student's goal—but she would also likely be terribly distraught and would have many follow-up questions. Is Lucy equipped to deal with the patient's emotional reaction and answer all of her questions about diagnostic possibilities, prognosis, effect on her transplant recovery, and so on? How might the patient feel now, knowing that a mistake may have been made, potentially exposing her to unnecessary risk? And to make things worse, now she thinks that her other doctors were aware and hid it from her—how might that affect her trust in her doctors and the system in general?

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Now let's assume that Lucy—for whatever reason—decides to obey Dr. Wong's directive to not tell the patient. What would happen next? Lucy would not get in trouble and eventually the patient would be told by one of the attending doctors. The patient might still be upset that people (including the student) knew and did not tell her. An attending doctor would likely be able to effectively manage the patient's emotional reaction and would be able to answer her questions about diagnostic and prognostic possibilities and create a mutually agreeable management plan.

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What does this have to do with evaluation? What if you had to evaluate Lucy, and she had decided not to tell the patient about the x-ray result? If you feel that ...

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