Editor's note: To provide you with a bit of context, Katherine is an American currently attending the Imperial College School of Medicine in London. This is her second article for BPC. To learn more about her background, check out her first article: The Road Not Chosen. -MS
Professionalism: the skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well."
While this description may be exaggerated, I do believe there is a smug sense of virtue to be found throughout the medical community. In the wake of recent student scandals that have attracted the attention of media and the stern eye of the UK’s General Medical Council (GMC), I took a moment to consider the importance of medical professionalism. These incidents include the Imperial Rugby team stripping naked on the Underground and the Imperial Medics Rugby team smashing the window of a coach, both during November, for which the college issued a joint statement. These incidents continue on from the scathing 2011 Daily Mail report on the med school’s student bar that led to a major crack down on student activities. Medical professionalism is obviously considered extremely important, but what is its role in medical practice? The Royal College of Physician’s 2005 report, Doctors in society: Medical professionalism in a changing world, states:
Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors."
While the literature shows mixed data on changes in physician trust in recent years, there is no doubt that the accessibility of medical information on the Internet has dramatically changed physician-patient interaction. The transition from doctor-centered care to patient-centered care, which has many benefits in its own right, may have also been necessitated by the increased knowledge patients are bringing to the table. For the scientists in my audience, doctor-centered care refers to doctors controlling the conversation with mostly yes or no questions and patient-centered care refers to letting patients express their ideas, concerns and expectations through open-ended questions. Patient-centered care has been shown to improve outcomes, treatment adherence and patient satisfaction. With the shift to patient-centered care, the doctor-patient relationship is moving towards collaboration. While professionalism is still important, with these shifting dynamics, perhaps a more flexible interpretation would be more appropriate.
Although obvious, I think it should be emphasized, doctors are people too, and like our patients, fall ill as well. In cases of mental illness, particularly drug abuse, I believe doctors and medical students are perhaps given too little allowance. There are many studies that link intelligence and mental illness; for example, high academic performance is correlated with bipolar disorder. Thus it is important that the medical community and public consider this in context with the rigorous academic requirements of medicine and the stringent GMC requirements for fitness to practice. All of the incidents described earlier have brought into question the individuals involved’s fitness to practice. The GMC allows doctor’s to be tried for evidence that a doctor (a) has not kept their medical knowledge and skills up to date and competent, (b) have taken advantage of their role as a doctor or have done something wrong, (c) do not have the necessary knowledge of English to practice safely, or (d) are too ill to practice safely. I think the most dangerously subjective criteria under this framework would be: ‘have done something wrong.’ It is likely that the highest performing clinician will not be the GMC’s poster boy, and that should be okay. While public trust is important, social and personal conduct is not the most important measure of fitness to practice.
Trust is no longer the limiting, or indeed most important factor for promoting health in the community. I think that the skill and good judgment aspects of professionalism should be emphasized over the polite behavior. My altered perspective is likely cultural; a statement on medical professionalism from the American Medical Association simply asks physicians to:
...respect human life and the dignity of every individual; ...refrain from supporting or committing crimes against humanity and condemn all such acts; and...advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being."
Professionalism is as contextual as culture, and equally subjective. While it has a functional and necessary role in our healthcare system, I believe it is too often approached as an absolute. Particularly with the increasingly global community of doctors and patients, I believe flexibility in social standards may be vital in optimizing health delivery. In the end, very few medical students and doctors face GMC penalty, but a shift in attitude may allow a more accepting and supportive social community that can further lower this number.