Professionalism is an overused word in the medical industry. What exactly is meant by professionalism, and what should it mean to hospitalists? Wikipedia notes that a professional is one who earns a living from a specified activity that has standards of education and training that prepare members of the profession with the knowledge and skills necessary to perform the role required. In addition, professionals are subject to strict codes of conduct enshrining rigorous ethical and moral obligations.
Physicians are the consummate professionals; over centuries, we have been afforded the reputation of being one of the “highest-ranking” professionals within societies, along with divinity and law. We are held to very high standards, both in and out of the workplace, including arduous and rigorous standards of education and training. We are in one of the only professions that take the Hippocratic Oath at graduation. This oath requires us to swear to uphold specific ethical standards. Being a professional means we always act within our professional standards and advocate for our patients in all circumstances.1
Threats to Professionalism?
Over the past several decades, concern has been growing about a widespread decline in professionalism among physicians, a decline that extends beyond a single generation. There are many purported reasons for this erosion of professionalism; we need to first understand the threats to professionalism in order to guard against its erosion in ourselves and in the next generation of physicians.1
One major issue is that we do not have a common understanding of the nature of professionalism; the definition is both overused and misused. We often refer to professionalism by what it isn’t, rather than understanding what it is. For example, there are scores of definitions for “unprofessional” conduct in the medical industry, many of which refer to physician behaviors. These include actions that intimidate, berate, or bully others, regardless of the rationale or intent, and encompass any form of physical or psychological harm. The actions of the “disruptive physician” are often thought of as synonymous with unprofessional behavior. But professionalism is so much more than the absence of disruptive behavior. So part of the erosion of professionalism is an oversimplification of what it isn’t, rather than what it is.
Another issue with upholding professionalism over time is that many physicians forget their professional standards, because there are few “booster sessions” to remind us of why we practice medicine. Once we enter the workforce, we are confronted with so many obstacles to delivering good care to patients that we often feel overwhelmed or incapable of removing the real barriers to good care, and therefore incapable of fulfilling our mission. There are no regular “revivals” or checkpoints to refresh our memory of what we went into medicine to accomplish.
Although our ultimate goal is to take good care of patients, another threat to professionalism is that doing this often requires physicians to operate outside their “trained” knowledge and skill sets. It requires us to act on behalf of patients as an advocate in all aspects of their life, not just as a “diagnoser” or “prescriber.” As a result, maintaining the ideals of professionalism has become ever more complex, because the social determinants of health have a major impact on patient well-being and health, including access to food, housing, and transportation. Many times, diagnosing and prescribing have little impact on the patient’s outcome; these social determinants of disease take sole precedence. A patient’s education, income, and home environment have a much greater impact in determining their health outcomes than does access to prescription medications. This means that advocating for patient health and well-being extends far beyond the walls of a hospital or emergency room, a role in which most hospitalists are incapable and/or uncomfortable.1