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Professionalism in medicine
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What is Medical Professionalism?
Medicine’s contract with society
Ann Intern Med. 5 February 2002;136(3):243-246
Medical Professionalism Through the Centuries
Hippocratic Oath 5BC
The Oath of MaimonidesFirst printed in 1793
Physician’s OathWHO, 1948
Physician’s PledgeSMC, 1995
Physician Charter* 2005
“The physician fills two roles in society: healer and professional.”
Cruess SR, Johnston S, Cruess RL. Professionalsim for Medicine: Opportunities and Obligations. Iowa Orthop J. 2004; 24: 9–15.
Source: Drs R & S Creuss
What does medical professionalism mean to medical students, residents, academic faculty and patients?
All have three primary concerns:Clinical competencePatient RelationshipsCharacter virtues
MEDICAL EDUCATION 2007; 41: 288–294
FACULTY RESIDENTS STUDENTS PATIENTSKnowledge & technical skill
Decisiveness & being succinct
Reciprocity of patient-doctor relationship
Patient relationships
Value of life experience
Be available 24/7 Tone of voice & body language
Dealing with stress Peer-based duty Need for superior colleagues to respect students
Help patients make hard decisions
Power of resiliency Beyond normal demands for compassion
Caring, reassuring compassionate , approachable & give hope
Empowerment vs authoritarianism
Might hurt someone
Maturity Takes effort to remain compassionate
“See me, hear me, feel with me & be fair to us”Importance of
other staff members
Trust & spiritual angst
Have time for patients
Unique elements from the different focus groups
“Care more for the individual patient than for the special features of the disease. . . . Put yourself in his place . . . The kindly word, the cheerful greeting, the sympathetic look — these the patient understands.”
Sir William Osler (1849-1919)British (Canadian born) Physician & Mentor
Medical professionalism involves expectations and obligations on both the physician and society
Drs. Richard and Sylvia Cruess of McGill University leaders in Medical Professionalism
Expectations: The Public & The Medical ProfessionPatient’s/public’s expectation’s of doctors Medicine’s expectations of patients/public
Fulfill role of healer Trust sufficient to meet patient’s needs
Assured competence of physicians Autonomy sufficient to exercise judgment
Timely access to competent care Role in public policy in health
Altruistic service Shared responsibility for health
Morality, integrity, honesty Balanced lifestyle
Trustworthiness (codes of ethics) Rewards: nonfinancial (respect,status),financial
Accountability/transparency
Respect for patient autonomy
Source of objective advice
Promotion of the public good Perspectives in Biology and Medicine, volume 51, number 4 (autumn 2008): 579–98
We define medical professionalism as a set of values, behaviours, and relationships that
underpin the trust the public has in doctors
Working Party of the Royal College of PhysiciansClin Med. 2005 Nov-Dec;5(6 Suppl 1):S5-40.
Trust breaks down when expectations are not met
Doctor lacks trust in patient when patient doesn’t mention past medical history (especially if deliberate)
Patient lacks trust in doctor when the patient perceives a lack of professionalism
“Doctor is a pervert. He kept staring at my boobs.”
“Dr XXX is an impatient person who talks very loudly and is rude to me. He doesn’t understand the needs of the patient…”
Dr very tactless…he should evaluate his calling to serve patients. If this is not his vocation, I suggest he go change his trade. Apparently he has no love in doing what he is called to do.
Patient feedbackKTPH
SMC Ethical Code & Ethical Guidelines
Application of SMC Ethical Code in daily practice
Be dedicated to providing competent, compassionate and appropriate medical care to patients.
What do you do if you don’t know how to treat a patient?
How do you remain compassionate when your last patient turns up 30 minutes late for his appointment?
Be an advocate for patients’ care and well being and endeavour to ensure that patients suffer no harm.
Do you turn off life support in a brain-dead patient if the relatives refuse?
Euthanasia & Physician-assisted death overseas and in Singapore
Provide access to and treat patients without prejudice of race, religion, creed, social standing, disability or financial status. A doctor shall also be prepared to treat patients on an emergency or humanitarian basis when circumstances permit.
How do you give low income patients the best treatment when they can’t afford it?
What level of care do you give a foreign worker when they need emergency care but cannot pay?
Would you offer an active 71 year old aggressive treatment for breast cancer?
Abide by all laws and regulations governing medical practice and abideby the code of ethics of the profession.
What do you do if you face an ethical issue you don’t know how to handle?
Maintain the highest standards of moral integrity and intellectual honesty.
How do you balance the needs of the patient with the commercial needs of private practice?
A pharmaceutical companies wants to sponsor your research on their drugs – would you accept it?
Treat patients with honesty, dignity, respect and consideration, upholding their right to be adequately informed and their right to self determination.
Would you tell an alert elderly patient their diagnosis if their family asked you not to?
Your patient has terminal cancer and says she doesn’t want any treatment to prolong her life for another six months. What do you do?
Maintain a professional relationship with patients and their relatives and not abuse this relationship through inappropriate personal relationships or for personal gain.
What would you do if there was mutual attraction between yourself and your patient (providing you were both single)?
What if a patient left you a significant amount of money in his will?
Keep confidential all medical information about patients.
Your 70 year old expat (UK) patient is married to a 50 year old Singaporean. The patient has been diagnosed with stage IV cancer – who do you tell the diagnosis to first?
Your 55 year old male patient has been diagnosed HIV+ and won’t tell his wife. What do you do?
“You need to look and behave like a doctor looks and behaves, and just imagine what you would like a doctor to look like if you were going to be seeing them yourself.”
Professor Jane DacreVice-Dean and Head of Education at UCL Medical
School, London & GMC Council Member
“The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.”
Sir William Osler (1849-1919)
British (Canadian born) Physician & Mentor