PRIME often starts its courses by asking participants to make a list of the characteristics that they would want to see in a doctor who was treating themselves or a close relative if they were seriously ill. The results are pretty much the same wherever in the world the exercise is conducted, and include things like compassion, integrity, patience, good clinical knowledge and skills, approachability and humility. Together these and other similar characteristics might be regarded as essential attributes of medical professionalism (as well as describing the characteristics Jesus showed in His interactions with people). However, a recent article in Academic Medicine challenged the list-based approach to professionalism, saying that whilst lists were useful for teaching, assessment and certification, they risked obscuring the foundational purpose and demands of professionalism. The authors argue that rather than comprising a list of desirable values and behaviours, professionalism transcends these; it is the reason for creating such lists and acting in accordance with them. In this light, professional behaviours should be recognised as derivative of the belief system of professionalism. Professionalism is not merely an accounting of what physicians promise to patients and society. At root, it is the motivational force – the belief system -that leads clinicians to come together, in groups and often across occupational divides, to create and keep shared promises.1
The American Board of Medical Specialities defines professionalism as follows:
Medical professionalism is a belief system about how best to organise and deliver health care, which calls on group members to jointly declare (“profess”) what the public and individual patients can expect regarding shared competency standards and ethical values and to implement trustworthy means to ensure that all medical professionals live up to these promises.2
The authors say that defining professionalism as a belief system identifies foundational scientific and technical competency standards and shared ethical values as equally important in the purview of professionalism. Earlier definitions that focused on lists of values and character traits tended to conceive of professionalism as being only about ethical standards, so much so that ‘ethics’ and ‘professionalism’ often have been used interchangeably. There are hazards in conceptualising professionalism as a separate area of competence, equal to ethics and distinct from practitioners’ responsibilities to attain and maintain the technical and other skills necessary to provide quality care. The more professional groups recognise that technical, interpersonal, and values-based competencies make up interlocking sets of promises, all of which are required by professionalism, the more effective our training and assessment programs will be.
The paper concludes that recognising that professionalism is a normative belief system, and that its legitimacy is dependent on living up to its promise of ensuring that practitioners are trustworthy, forces serious consideration of what happens if professionals and their organisations fail to establish credible means of ensuring that practitioners are worthy of trust. Believing in professionalism means holding the conviction that medical professionals can come together to establish and enforce standards for competence and ethics, and that society is best served when health care is entrusted to these professionals. But not everyone believes in professionalism. In fact, there are prominent alternative belief systems about how best to organise and deliver medical care, including consumerism and other ‘-isms’. This new definition calls attention to the fact that if professionalism fails to ensure trustworthiness, if the public no longer believes in professionalism, it can be revoked in favour of substitute belief systems that rely less on patient and public trust in health practitioners, a trend which we are now seeing in many countries, including the UK.
PRIME would agree with the key arguments here. It is our motivational force and belief system (that all patients are human beings created in the image of God) that drives the professional behaviour (including the desire to be as technically up to date and good as possible in our speciality) that is defined by the lists of characteristics, which include ‘technical, interpersonal, and values-based competencies’.
Let us all take care that we retain the motivational belief system that drives us to be true professionals, seamlessly integrating the values we hold and demonstrate in practice, with technical and scientific excellence. The people we serve deserve nothing less.
1 Wynia MK et al. More Than a List of Values and Desired Behaviours: A Foundational Understanding of Medical Professionalism. Academic Medicine, Vol. 89, No. 5; May 2014
2 Hafferty F, Papadakis M, Sullivan W, Wynia MK. The American Board of Medical Specialties Ethics and Professionalism Committee Definition of Professionalism. Chicago, Ill: American Board of Medical Specialties; 2012.