The Dangers of Power, Prestige and Profit in Medical Education.

A letter to the editor of the January edition of Academic Medicine(1) comments on an earlier paper that was referred to in a previous international email.  The authors say “we read with interest Lown and colleagues’(2) recent article on integrating a compassionate, collaborative care (the ‘triple C’) model into health professions education.  Their work provides an excellent framework for moving closer to achieving Berwick and colleagues’ ‘triple aim’ of improving patients’ health and enhancing their experiences of care while concomitantly reducing costs. Organisational psychology suggests, however, that little substantial progress will be made until other issues – adaptive challenges that block changes in behaviour – are brought out from the shadows, honestly examined, and coped with creatively and responsibly. In medical education and practice these underlying issues commonly form the ‘triple P’ of power, prestige, and profit, especially when valued as terminal objectives on their own.

We are concerned that the ‘triple P’ factors have not yet been explicitly acknowledged and will thus continue to work against the development of compassionate organisational learning and service environments.  We suggest that those interested in promoting more humanistic health care explore how power, prestige, and profit both add to and detract from progressive initiatives that support organisational professionalism.  We encourage them to address these ‘triple P’ factors as an unambiguous step toward transparency and efficacy on their paths to reforming medical education and practice.”

This is a well made point.  Medical educators always need to be conscious of the ‘hidden curriculum’ – the unspoken but often powerful messages that are conveyed to learners by the behaviour and attitudes of their teachers. Unfortunately in medicine it is not unusual to come across those who are motivated by the desire for power, prestige and profit, and we need to be on the lookout for the negative effect this can have on our students.  As those ‘interested in promoting more humanistic healthcare’ we must challenge and expose these negative attitudes wherever we find them.  I have long been convinced that our key role as medical teachers is the identification, promotion and (most importantly) modelling of the right attitudes.  A caring, compassionate, equitable and justice seeking orientation is vital if we are to see healthcare worldwide transformed in a way that restores its heart (which is PRIME’s vision).

In many parts of the world, sadly the medical professions are unashamedly focused on profit and prestige in particular, and these may even be used as enticements in recruiting students. This poses a major challenge for PRIME partners and like-minded colleagues working in those places.  Wherever we are, in our own practice and teaching let us not shrink back from exposing these inappropriate motivations and boldly replacing them with compassion, integrity and respect for the dignity of every human being, which should lie at the heart of the provision of healthcare everywhere.

References:
1.    Ventres, W, McAuliffe, J. The Triple P: Adaptive Challenges in Medical Education and Practice.  Acad Med. 2017;92:10
2.     Lown BA, McIntosh S, Gaines ME, McGuinn K, Hatem DS. Integrating compassionate, collaborative care (the ‘triple C’) into health professional education to advance the triple aim of health care. Acad Med. 2016;91:310–316.

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