Professionalism in medicine has long focused on the tenets of patient welfare, patient autonomy and social justice. As health care has evolved, our definitions and value statements have broadened. Evidence-based medicine, quality improvement, access to care, cost-effective practices, and conflicts of interest are now at the forefront of these discussions—all of which are salient in hospital medicine.
The 2002 jointly published Medical Professionalism in the New Millennium: A Physician Charter articulated fundamental principles and responsibilities to which all physicians should aim to maintain. The ABIM Foundation, The European Federation of Internal Medicine, and the ACP Foundation worked together to develop a charter that reconciled the selfless expectations of the physician with the ever-changing landscape of health care delivery. The American Academy of Pediatrics’ Committee on Bioethics followed with their policy statement on professionalism in pediatrics, which addressed some of the unique considerations for those caring for children.
Hospitalists are trusted with the well being of some of the most vulnerable patients. This distinctive contract with society calls for some variation in our emphasis when discussing professionalism. Here we will define professionalism in hospital medicine, clarify concepts most applicable to those caring for hospitalized patients, and translate this into clinical practice. These concepts apply to all clinicians at all levels, team members, and hospital systems caring for patients admitted to the hospital.
WHAT DOES “PROFESSIONALISM” MEAN IN HOSPITAL MEDICINE?
Members of any profession are expected to have acquired a body of knowledge and skills specific to their chosen field. Through a shared commitment, there is self-regulation and a contract with society to judiciously apply skills and expertise. Hospitalists, like all physicians, have made an agreement to heal. This pact requires an establishment of trust and a willingness to place patient needs above all other considerations. Self-regulation is administered through state medical boards, clinical leadership, and ethical codes. Professionalism is what binds this treaty to our profession.
The high stakes and lack of predictability in caring for inpatients creates unique challenges for hospitalists. Beyond the standard definitions of medical professionalism, special emphasis on patient safety, provider interdependency and communication, financial reimbursement and patient satisfaction reshape our understanding and must always be considered. Finally, with a substantial component of undergraduate, graduate and interprofessional training taking place in the hospital setting, the impact of hidden curricula in medical education is arguably greatest in hospital medicine. Given this, the ripple effects of our behaviors are far reaching. Professionalism for the hospitalist translates to more than outcomes for patients—it has the potential to define generational culture in medicine.
PROFESSIONALISM AND PATIENT SAFETY
Safety for hospitalized patient relies upon a collaborative work climate, teamwork, and effective communication. Intimidating and disruptive behaviors have been linked to increases in medical errors, poor patient satisfaction, cost of care and higher rates of attrition for staff. Behaviors ...