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Medical Professionalism: More Than Simply a Job
Malathi Srinivasan, MD
JAMA. 1999;282:814.
As physicians, we have all seen disrespectful and antagonistic behavior exhibited by colleagues. Egregious unprofessional behavior, like exemplary behavior, is almost always apparent to patients, colleagues, and other observers. I can remember long call nights when I spoke about patients in disparaging ways or became provoked and did not uphold my personal standards. During those moments, my behavior fell short of the professional standards I had pledged to uphold.
I am not alone in my lapses. In one institution, approximately 20% of anesthesia residents were cited for unprofessional behavior by their attending physicians during rotation evaluations.1 Other studies have demonstrated that these behaviors occur up to once an hour,2 and that when they do occur, they are often ignored.3
We can change the learning climate to reinforce professional behaviors, such as respect, compassion, altruism, accountability, service, and life-long learning. Research has demonstrated that behavioral patterns can be taught.4 To help create better physicians educators should:
- Reinforce positive behavior by rewarding models of exemplary patient care and collegial respect. I once observed a pulmonary chief of service keep his cool when another service challenged his patient care decisions, then explain why his antibiotic choice was appropriate, and—most importantly—compliment the acumen of the other team after they had left.
- Address negative behavior through existing educational modules for improving teachers' ability to address unprofessional behaviors in nonpunitive ways that can lead to improved learner behavior.5 We should also promote the development of new models.
- Address underlying issues by improving working conditions, providing adequate time off, and protecting learning time—all important components that show a commitment to teaching and learning. Improving the working environment will promote professional attitudes.
- Set superb examples by modeling compassionate patient care, active community/professional service, and honest collegial respect. Despite provocations or burnout, physicians must learn how to maintain presence of mind, always use professional language, and act in a professional manner.
Professionalism is integral to the practice of medicine. The foundations of our collective professionalism are being severely tested by major changes in both medical education and the health care marketplace. But the challenge to behave professionally is also a personal test that occurs daily, in increments.
Whenever my patience is taxed and I feel unable to maintain my equilibrium, I try to view myself through the eyes of my students and patients. Each day I ask myself the question that tests my professionalism, "Can I be proud of who I appear to be?" With any luck, it's a test I'll pass.
National Research Service Award Fellow
Indiana University School of Medicine
Indianapolis
REFERENCES
1. Rhoton MF. Professionalism and clinical excellence among anesthesiology residents. Acad Med. 1994;69:313-315.
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2. Stern DT. Professionalism on call. J Gen Intern Med. 1996;11(S1):109.
3. Burack JH, Irby DM, Carline JD, Root RK, Larson EB. Teaching compassion. J Gen Intern Med. 1999;14:49-55.
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4. Skeff KM, Stratos G, Berman J, Bergen MR. Improving clinical teaching. Arch Intern Med. 1992;152:1156-1161.
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5. Srinivasan M, Bogdewic SP, Litzelman D, et al. Effectiveness of a faculty development course on "Teaching Caring Attitudes." J Gen Intern Med. 1999;14(S2):156.
Prepared by Ashish Bajaj, Department of Resident Physicians Services, American Medical Association.
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