Professionalism

Professionalism

CONCEPT OF PROFESSIONALISM

Society provides a profession with economic, political, and social rewards. Professions have specialized knowledge, and when it is difficult to measure the quality of its work, a profession has the potential to maintain a monopoly on power and control, remaining relatively autonomous. The profession's autonomy can be limited by societal needs. A profession exists as long as it fulfills its responsibilities for the social good. In the past, simply being a physician was considered by many to be a sufficient measure of high-quality health care.

Today the medical professional's activities are subject to explicit public rules of accountability. Governmental and other authorities, whose function is to foster social and distributive justice and the public good, grant limited autonomy to the professional organizations and their membership. City and municipal government departments of public health establish and implement heath standards and regulations. At the state level, boards of registration in medicine, with powers to investigate physician impairment, establish the criteria for obtaining and revoking medical licenses. The federal government has an increasing role in funding direct medical care and regulating the standards of services, which include national programs such as Medicare and Medicaid and the Food and Drug Administration. The Department of Health and Human Services regulates physician behavior in conducting research with the goal of protecting human subjects. The Health Care Quality Act of 1986 authorized the federal government to establish The National Practitioner Data Bank, which began in 1990. This data bank contains information about physicians (and other healthcare clinicians) who have been disciplined by a state licensing board, a professional society (local or national), a hospital, or a health plan.

Practitioners who have been named in medical malpractice judgments or settlements also are included. Hospitals are required to review information in this data bank every 2 years as part of clinician recredentialing. There are accrediting agencies for medical schools (Liaison Committee on Medical Education) and postgraduate training (Accreditation Council for Graduate Medical Education [ACGME]). The ACGME includes establishing committees that review residency subspecialty training programs. At the individual physician level, the various specialty boards determine the criteria for competency for practice, including various examinations for board certification. Specialty certification is time limited, and physicians who wish to retain their certification are re-examined periodically. State boards of registration also adjudicate the question of the competence of the physician on an individual basis.

Historically, the most privileged professions have depended for their legitimacy on serving the public interest. The profession should be the guardian of social values emanating from that profession and negotiated with the public. A profession should not become more concerned about its own business, economics, and political interests than the interests of the people it serves. The public trust of physicians is based on the physician's commitment to altruism. The ACGME has established competency standards for its accreditation of residency programs. Among numerous required competencies is that of professionalism, which embodies altruism. Many medical schools include variations on the traditional Hippocratic oath as part of the commencement ceremonies as a recognition of a physician's responsibility to put the interest of others ahead of self-interest.

The core of professionalism is embedded in the daily healing work of the physician and encompassed in the patient-physician relationship. The goal in this relationship is to act in the best interest of the patient using all of the technologic, scientific, and humanistic experiences available. Professionalism includes an appreciation for the cultural and religious/spiritual health beliefs of the patient, incorporating the ethical and moral values of the profession and the moral values of the patient. Professionalism includes the family and the community as an important element of the healing perspective. The community perspective includes advocacy for the individual patient and advocacy for the community.