As medical students, residents, and practicing physicians, we all strive to be professional. We are dedicated to our work with patients and we strive to provide the highest level of excellence in all aspects of our work. We learn the codes of professionalism that govern medicine, starting from the Hippocratic oath that we all recite when we graduate from medical school to the modern day Physician Charter. Yet, despite our good intentions and the modern day charter, many of us think of professionalism as an abstract concept, a theoretical aspirational goal, or a set of written principles, rather than a set of core skills that we use in our daily clinical care, learning, and teaching.
This book will show that medical professionalism is part of our routine work and we do it best when we have specific skills. It is not just a theoretical concept or a set of principles distant from our clinical practice. This book is about medical professionalism in our work as students, residents, and practice physicians. It is also about professionalism in our medical institutions and hence, administrators and medical leaders are part of our target audience. We have designed this book to be highly practical and to help our readers develop or deepen their professionalism skills. Chapters include clinical scenarios all based on our personal experience in teaching and clinical care, learning exercises to stimulate active participation of readers, and “challenge cases.” This is not a book about theory (although it includes some theoretical background); rather it is written to engage readers in reflection about professionalism in their own work.
There are several key premises of the book:
First, we define professionalism as a set of behaviors that can be demonstrated in our daily work. Defining professionalism as behaviors, enabled by specific skills that can be taught, and learned, makes “professionalism” practical and relevant.
Second, challenges to our professionalism occur every day in all clinical settings. Often physicians think of breaches of professionalism as something that most readers will never encounter; breaches where physicians commit serious offenses—like having sexual relations with patients. This is not our concept of every day professionalism challenges. Rather we think breaches in professionalism occur routinely in clinical care and teaching: the dilemma for a trainee of the need to adhere to work hour restrictions versus going to spend more time with a patient; observing or participating in a medical error that is undisclosed to the patient; disrespectful communication between physicians and nurses. These are all common examples of challenges to medical professionalism. We live with these challenges all the time. We need specific skills to handle them well.
Third, the responsibility to demonstrate professionalism is shared by individual physicians, the healthcare team, the medical institution, and medical professional organizations. Most physicians think that “being professional” is all their responsibility and often one that is a difficult burden to bear. Our premise is a novel one—medical professionalism is a system issue. All the stakeholders in the system can strive to enhance professionalism and can also create barriers to professionalism in a medical environment. Hence, the corollary is that all the stakeholders—trainees, physicians, healthcare team members, healthcare administrators, and leaders of professional organizations—have a key and important role to play.
Fourth, skills in medical professionalism need to be developed continuously over our lifetime. Just like we continuously learn new skills in diagnosis and treatment, we can and must keep learning how to demonstrate our professionalism in our daily work. The challenges we face are opportunities to learn new skills—just like seeing a rare presentation of a disease is an opportunity to deepen our knowledge and skills about diagnosis and treatment. Professionalism is a competency developed over time—that ca n result in mastery. We all need to develop “professional resiliency”—the ability to respond, based on skills, to challenging situations that inevitably arise.
The book presents professionalism in a behavioral and systems approach. This is done by a chapter that presents this core framework at the beginning (Chapter 1). The chapter presents our view that there are four key values that underlie medical professionalism—delivering patient-centered care; integrity and accountability; the pursuit of excellence; and the fair and ethical use of resources. For each of these values, there are specific behaviors that physicians, team members, healthcare administrators and leaders can demonstrate. Hence, the book has one chapter addressing each of these four values and presenting the specific behaviors and skills necessary to demonstrate that component of professionalism (Chapters 4, 5, 6, and 7).
Chapters on education and evaluation are relevant and practical for practicing physicians, medical students, residents, and faculty. These chapters are replete with learning and evaluation tools. Learning exercises are designed to allow readers to test their ability to handle professionalism challenges and to develop new approaches.
We are delighted to share this book with our readers who we hope will include students, residents in all specialties, faculty members, practicing physicians, healthcare administrators, and healthcare leaders. All of these healthcare professionals seek to achieve the highest level of professionalism in their care of individual patients, populations of patients, learning environments and care delivery systems. We hope this book will provide practical ways to make their efforts most effective. We think that readers will have fun working on the professionalism challenges presented in vignettes and learning exercises that are common situations we face in our daily work.