The medical profession has traditionally enjoyed a highly respected position in society. This position is threatened not only by the overt unprofessional behavior and attitudes of some individuals, but also by ongoing changes in the health care system.
Rapid advances in medical knowledge and technology are putting increased pressure on medical professionals to process huge quantities of information, with time consuming but essential requirements for continuous updating of knowledge and skills. Changes in the health care system have created a competitive environment with more stress factors. These new demands and the expectations of the public and the medical community have altered the image of the medical professional. Professionalism, once so ingrained in that image, must be preserved and enhanced.
With the external pressures imposed on it, the medical profession is facing a critical moment in time. Its ability to retain its leadership role in society depends largely on its willingness to abide by a standard of excellence and behavior. Individuals must maintain a commitment to professional ethics and high standards of moral and ethical behavior. As members of the academic medical community, professionals are obligated to set an example for both their students and community peers.
While knowledge and technical skills are crucial in medicine and science, the manner in which they are used is equally important. All medical professionals must strive to retain those humanistic qualities that constitute the essence of professionalism. These qualities apply to all aspects of the professional's life, including the relationships between medical professionals, between specialties, and between professional organizations.
Core Components of Professionalism
Altruism is the essence of professionalism. The best interest of others including patients, colleagues, mentors, and trainees, rather than self-interest, is the rule.
Accountability Medical professionals are accountable to their patients, colleagues, and society as a whole for the health needs of the public and the advancement of science. They are accountable to their profession for adhering to medicine's time-honored ethical principles.
Excellence is a conscientious effort to exceed expectations and to make a commitment to life-long learning. Commitment to excellence is an acknowledged goal for all medical professionals and should begin on the first day of Medical School.
Duty is the free acceptance of a commitment to service. This commitment entails being available and responsive when needed, accepting inconvenience to meet the needs of patients, advocating the best possible care regardless of ability to pay, seeking active roles in teaching and professional organizations, and volunteering skills and expertise for the welfare of the community.
Honor and integrity are the consistent regard for the highest standards of behavior and the refusal to violate personal and professional codes. They imply being fair and truthful, keeping one's word and meeting commitments. They also require recognition of possible conflicts of interest and avoidance of relationships that allow personal gain to supersede the best interest of the profession.
Respect for others, including patients, their families, and other professional colleagues is the essence of humanism, which is both central to professionalism, and fundamental to enhancing collegiality among medical professionals.
A personal commitment to life-long learning is essential to assure the highest quality of medical care and scientific progress and stay abreast with the constant changes in scientific information, technology, and tools. This commitment must be accepted from the very beginning, and must be honored throughout one's life as a physician and scientist.
Challenges to Professionalism
Abuse of Power - Abuse of power can take many forms: not allowing patients to contribute to decision-making in their own care; allowing financial and academic competitiveness to affect judgment, including the honest evaluation of peers and trainees; using the work of junior colleagues to enhance one's academic career; deliberately hindering the academic development of junior colleagues; the unwarranted undermining of junior colleagues; medical student abuse and abusive behavior toward colleagues. The respect and trust of patients and professional colleagues are to be cherished, not abused.
Discrimination, bias and harassment - The medical profession has a particular responsibility to ensure an environment where all colleagues can enjoy equal respect and advance to their full potential, irrespective of disability, ethnicity, gender, race, or religion. Inequities that impair the professional and personal development of any individual cannot be allowed. Even seemingly minor events, such as ethnic or gender-related jokes, may create a hostile environment which negates the basic principles of humanism in the medical profession. Medical student abuse is a problem formally recognized only in the early 1980's. It has been well described in the medical literature. Such behavior, whether directed toward medical students or professional colleagues, is unacceptable at the University of Kansas School of Medicine.
Breach of confidentiality - Patients trust that conversations and information obtained as part of the patient/physician relationship will be held in strictest confidence. This trust is not to be violated. Casual comments or discussion of patients in public are breaches of confidentiality and are unacceptable. Disclosures are allowed only in the course of patient care, in the patient's best interest or when disclosure is a legal requirement. Likewise, confidential communications of scientific data, manuscripts and intellectual property should not be used for personal gain or divulged publicly.
Arrogance - Arrogance is an offensive display of superiority and self-importance. Unfortunately, by their nature, medicine and science can foster arrogance in the medical professional. The training is long and arduous with a seemingly endless mass of knowledge, which at times feels impossible to master. Students of science are thus prone to assume an air of self-importance, having survived such an initiation. Arrogance destroys professionalism by reducing the individual's ability to think for himself or herself, making empathy for others difficult and removing the checks and balances of self-doubt.
Greed - Greed can be defined as the inappropriate aspiration of fame, power, or money. Greed impairs altruism, caring, generosity and integrity and therefore negates professionalism. In order to avoid greed, it must be recognized as a potential component of professional lives, and the medical professional must constantly re-evaluate his/her motives to ensure that no actions are dictated solely by personal gain.
Misrepresentation - In the context of unprofessional behavior, misrepresentation consists of lying and fraud. Lying requires a conscious effort to not tell the truth. It is not simply relating an untruth, or any erroneous statement could be construed as lying. Lying about class assignments or experiments, or misrepresenting patient related data because of failure to complete an assignment or find the correct information, are serious breaches in professionalism, which raise the specter of overall dishonesty in the individual responsible. Fraud is a conscious misrepresentation of information with the intent to mislead. It can occur in both medical practice and research. Lying about the services performed in order to obtain reimbursement and misrepresentation of experimental data are examples of fraud.
Impairment - Medical professionals who are impaired in their ability to carry out their professional obligations must relinquish their responsibilities, particularly when caring for patients. Impaired cognitive abilities and judgment due to illness are no less common among medical professionals than among the public at large. While severe impairment may be easy to recognize, marginal impairment may not be readily detectable and doubt may exist about whether it is even present. Reluctance to draw attention to an impaired or potentially impaired colleague is a significant problem associated with this aspect of medical professionalism. Rationalizations that inhibit prompt and appropriate action are common, but inaction in dealing with an impaired colleague is a failure of professional obligation.