What is Professionalism in Medicine?
Professionalism embodies the relationship between medicine and society as it forms the basis of patient-physician trust. It attempts to make tangible certain attitudes, behaviours, and characteristics that are desirable among the medical profession. Although professionalism has been incorporated into most medical schools across North America, it remains rather difficult to define because it carries many connotations and implied meanings. What is certain, however, is that medicine is a moral endeavor which demands integrity, competence, and high ethical standards among other key attributes.
At our own University of Ottawa, Dr. John Seely as Dean of the faculty of medicine (in the 1990’s) created the professional standards expected of faculty, students and staff in respect to patient care, research and education. These are now embodied in the faculty calendar (see the section Professionalism at uOttawa).
Professionalism does not attempt to dictate every minute detail of the fiduciary relationship between a patient and his/her physician, but rather sets forth an ideal which medical students, residents, and physicians can all aspire to throughout their medical careers.
Drs. Richard and Sylvia Cruess of McGill University have become leaders in the field of medical professionalism. They describe the role of the physician as overlapping between that of the healer and that of the professional. Within this model, both positions are necessary to appreciate key attributes of the physician. Although the primary role of the physician is undoubtedly that of the healer, one must simultaneously maintain professionalism in medical practice. The following diagram highlights this crucial balance:
http://www.afmc.ca/pages/professionalism/1CruessSlides.ppt Accessed July 2007.
The Cruess’ also describe the relationship between medicine and society as a social contract complete with expectations and obligations on both parts. Fundamental to this social contract is trust: trust in the physician by the patient and trust in the system by the physician (2). Furthermore, the individual patient’s expectations of his/her physician mirror societal expectations of medicine in general. Altruism, morality, and accountability are a few of the many characteristics expected of every physician. In order for such a contract to function as successfully as possible, both sides must fulfill their respective obligations. Thus, the social contract between medicine and society is based on reciprocity, details of which are outlined in the following table (3):
Society's Expectations of Medicine
- Services of the healer
- Assured competence
- Altruistic service
- Morality and integrity
- Source of objective advice
- Promotion of the public good
Medicine's Expectations of Society
- Health care system
- Adequately funded
- Participation in public policy
- Shared (patients and society) responsibility for health
- Status and rewards
In 2005, the Royal College of Physicians and Surgeons of Canada (RCPSC) published the second version of CanMEDS, The CanMEDS 2005 Physician Competency Framework (6). This framework offers the following definition of a professional:
"As professionals, physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behaviour."
To view the 2005 CanMEDS Physician Competency Framework published by the Royal College of Physicians and Surgeons of Canada (RCPSC), go to http://www.royalcollege.ca/portal/page/portal/rc/canmeds/framework
How do the ethics of professionalism differ from clinical ethics or bioethics?
The term "ethics" simply refers to a system of moral principles or standards governing conduct (9).The difference between clinical ethics, bioethics, or any other form of ethics is the subject matter to which the ethical principles pertain.
Bioethics is essentially an umbrella term for moral conduct in the broad area of life sciences and medicine (12). As described by the World Health Organization, bioethics deals with issues related to health and health care management, animal welfare, and environmental issues. It also encompasses the following subject areas: philosophy of science, biotechnology, politics, law, medicine, and theology.
Clinical ethics tackles patient-based ethical decision making. A subset of bioethics, clinical ethics and medical ethics are often used interchangeably. This area of ethics considers different judgments as they apply to the clinical practice of medicine. Thus, clinical ethics is a system of principles governing medical conduct with respect to patients and their families.
The ethics of professionalism in medicine is more concerned with the characteristics and behaviours of physicians in the context of medicine as a profession. Specifically, it examines desirable and undesirable attributes of physicians (4). Desirable behaviours include altruism, accountability, excellence, duty, honor, integrity, respect for others, and a commitment to lifelong learning (1,4). Undesirable conduct, on the other hand, includes abuse of power, bias, sexual harassment, breach of confidentiality, arrogance, greed, misrepresentation, impairment, lack of conscientiousness, and conflicts of interest (1,4). The ethics pertaining to professionalism not only motivate patient-physician interaction, but also outline expected behaviour with other physicians, health care workers, medical students, and preceptors.