Medicine’s Evolution Shouldn’t Undermine Your Expertise, Autonomy, Professionalism
I’m a career hospitalist, yet I struggle to define my role in medicine. Am I still a professional even though I do shift work?
—Randy Robison, DO, Plano, Texas
Dr. Hospitalist responds:
Simple question. The short answer is “yes.” The long answer is as follows, so stay with me as we go on a bit of a tangent.
Physicians historically have been categorized as independent professionals, and that was never more true than when most physicians operated in small or solo practices. If you go back even further than that, historically, the three “learned professions” are divinity, medicine, and law. A rough definition encompasses the idea of standard training, a regulatory body (or bodies), and a code of ethics.
Without arguing about how many angels can dance on the head of a pin, let’s translate the idea of a profession into something equating autonomy. Professional autonomy can come in many forms. Decision-making at the bedside is a prime example. From a clinical perspective, the advances that we have made in evidence-based medicine are laudable. While some might view the advent of protocols as constraining, I think it allows for a clearer application of science while leaving the art of medicine in the hands of the individual. Others will counter that there’s too much Ritz-Carlton training going on for physicians now, reducing the autonomy of the individual practitioner.
On some level, I’ve been hearing about the “loss of professionalism” in medicine since the day I entered medical school. That said, as a hospitalist in the field of internal medicine, there is not a day that goes by when I don’t have a clinical question with several possible “right” answers. At the same time, there are often varying communication approaches to the patient as well, based on gender, age, education, ethnicity, values, and so on. So I don’t get the sense that autonomy is dead.
There is no doubt that we live in a time of great upheaval in healthcare. Any significant changes can be threatening, especially to a professional. It’s even harder when that independent professional depends on the government as both their greatest source of income and regulation. “Government functionary” and “independent professional” are not exactly ringing synonyms.
Yes, the payment system is in flux. Yes, there is less true autonomy than 20 years ago, and maybe that’s a good thing for our patients. Yes, there are greater expectations for behavior or customer service. Yes, more of us do shift work of some sort than we did before.
Still, there’s no reason to be a lackey, and there’s no reason not to take pride in what you do. Consider these conflicting statements: Show up on time. Question authority. Dress worthy of your calling. Be an individual. Honor the data. Know your own opinion.
At the end of the day, each patient needs you. They need your knowledge, your compassion, your time, and your commitment. It has nothing to do with when your shift starts or when it ends. It has everything to do with the pride you take in your profession. Every patient who has an encounter with a hospitalist should come away thinking, “Wow, that physician is really on the ball. They know all the recent data, they treat me with courtesy and respect, and they have a personality to boot.”