Spending the past decade as a dean for medical education charged with overseeing both undergraduate and graduate medical education at the University of Chicago, and for more than a decade before that serving as a residency program director, I have spent a considerable part of my career tackling modern-day issues of medical professionalism from the onset movement in the 1990s. In my various roles, I have sympathized with students who told me that being lectured to about professionalism is demeaning, discussed with residents the complexities of adhering to duty hours while ensuring that patients are well cared for, and brainstormed with faculty about elevating the ideals of professionalism across the entire medical enterprise.
Teaching professionalism is difficult. It can also be frustrating—how do you teach and impart core values? Influencing and creating a clinical learning environment can take years to bear fruit. This book's authors understand the profession's struggle and expertly reframe the issues by refocusing our attention on practical, specific behaviors, and coping techniques, while enlarging the discussion to focus on societal and systemic concerns. How can we thoughtfully design our healthcare system and our educational endeavors to help health professionals provide the best care for patients?
Implicit in nearly every discussion of professionalism up to this point is the hidden assumption that being professional is an immutable character trait, and one that the physician alone must carry. If a student, resident, or faculty member fails to act professionally, they have failed the profession. That is a heavy burden for anyone to carry and as educators we have asked our most inexperienced trainees to do just that. This book relieves us of the burden of this moral superiority.
Physicians are not, as Chapter 3 so aptly describes, superhuman. And being professional is not a superpower. It is a skill and competency which can be taught, and one that must be developed over our entire careers. Being professional, it turns out, is learning how to be completely human—learning how to manage challenging ethical situations, practicing telling patients “no” when they ask for unwarranted tests, and learning strategies for how to build up personal reserves so that we are better prepared to manage professional challenges. This requires practice. Throughout this book we are introduced to helpful tools. Communication training, faculty role modeling, the use of checklists and other rubrics focused on patient-centered care may all prove useful. The authors rightfully acknowledge that throughout the day, all health professionals struggle to act professionally. Occasional lapses in professional behavior are not character flaws, they are opportunities for learning. These opportunities appear at every level of practice, whether we are students, residents, or seasoned practitioners.
The message is clear: upholding the trust that our patients have placed in our hands is difficult. We all need guidance. Using challenge cases, checklists, and tables, this book provides the tools to help us bring the best version of ourselves to our daily interactions with patients. In today's world, being professional is synonymous with working in and leading team-based care. Physicians cannot and do not single-handedly treat patients. Professionalism is not an issue of physician behavior—it is an issue of the team's behavior—and fundamentally—an issue related to the healthcare system. Expanding the definition of professionalism beyond the physician does not abdicate the physician's responsibility for the patient; it simply expands the definition to acknowledge that all members of the healthcare system are equally responsible for providing the best possible care for patients. What does this mean for the nurses, assistants, and administrators who work with us to provide patient care? We are asking nurses and other healthcare professionals to help us by providing feedback when our behavior is not serving the patient. Fundamentally, this evolving definition means a willingness and openness to accept and learn from feedback—a fundamental acceptance of partnership.
Understanding Medical Professionalism places the issue of physician professionalism within the context of the healthcare system. Once we accept that professionalism is a competency that can be learned, we open up the possibility of focused interventions and systemic solutions. How can physicians influence the system and be advocates for change? Quite simply, get involved. This may take the form of participating in accreditation processes, quality task forces, or patient safety committees. Every day I work with medical students and residents who embrace civic professionalism and literally change the way our hospital does its business. The view from the trenches through the eyes of our students and residents provides a rarefied lens through which to see the world of healthcare. This view combined with their dedication and passion make a powerful impact for patients. The practical exercises in this book invite us all to reconnect with the thrill we experienced as students when we put on our white coat for the first time and believed that we could make a difference.
Understanding Medical Professionalism represents an important step forward in the ongoing discussion of medical professionalism. Hampered for decades with concerns that lapses in professional behavior were linked to deficits in character, this book reminds us to lay down our insecurities and defenses, acknowledge we all stumble in consistently being our best professional selves, and then invites us to roll up our sleeves, and get to work learning and relearning how to be professional in today's complex environment. Now is the time to create healthcare teams, institutions, and systems that foster an environment of respect, learning, and compassion to deliver the best possible care for patients. This book will help you do exactly that. Let's get started!