1. Anita R. Webb, PhD JPS Family Medicine Residency Fort Worth, Texas
PROFESSIONALISM
Anita R. Webb, PhD
JPS Family Medicine Residency
Fort Worth, Texas

2. Goals Awareness of your professions’ expectations
Awareness of your specialty’s expectations
Awareness of your colleagues’ expectations
Awareness of the public’s expectations
Awareness of your own expectations

3. WHY? Claims of declining public image of physicians
“Dehumanization” in medical care
“Physicians have become less compassionate and too detached.”
Hojat M et al. Physician empathy in medical education and practice. Seminars in integrative med 2003;1:25-41.
The Business Case: building a successful practice
Regulatory bodies: Seeking tools to address breakdowns in professionalism

4. Alarm in Regulatory Bodies
The Joint Commission (JCAHO)
Rude language and hostile behavior threaten patient safety and quality of care
“Sentinel Event Alert” July 2008
“Zero tolerance” beginning January 2009
Powers K. Joint commission alert: stop bad behavior among health care professionals.

5. Social Contract
Does the profession of medicine have a “contract” with society?
Purpose of contract?
What does society expect from physicians according to this contract?

6. Expectations (cont.)
What would physicians expect from society according to this contract?

7. HISTORICALLY Hippocratic Oath Classical version Modern version (1964)

8. Professionalism Is Expected
Professional competence is the habitual and judicious use of
Communication
Knowledge
Technical Skills
Clinical Reasoning, emotions, values
And Reflection in daily practice
For the benefit of the individual and community being served.
Epstein RM, Hundert EM. Defining and assessing professional competence. JAMA. 2002;287:

9. U.S.A. American Medical Association Nine principles of medical ethics
(2001/2004)
(next two slides)

10. AMA: Nine Principles 1. Medical care: competent, compassionate
2. Professional standards: honesty, etc.
3. Law abiding, advocacy for patients
4. Confidentiality, privacy, respect rights
5. CME, collaboration, referral

11. AMA (cont.) 6. Physicians’ freedom of choice
7. Community involvement, public health
8. Responsibility to patient as paramount
9. Access to care for all people

12. International “A Physician Charter” “Professionalism Project”
The Lancet, Feb. 9, 2002 (vol.359):
“Professionalism Project”
Medical Professionalism in the New Millennium: “A Physician Charter” Ann Int Med 2002:136(3)
What is a charter?
Guarantee of basic rights

13. Preamble What society expects of physicians: 1. Altruism 2. Competence
3. Integrity
4. Expert advice

14. Foundation Three “Fundamental Principles”
1. Primacy of patient welfare
2. Patient autonomy
3. Social justice
Fair distribution
No discrimination

15. Specific “Responsibilities”
Competence
Honesty
Confidentiality
Appropriate relationships
Improving access
Improving quality
Just distribution
of finite resources
Commitment to scientific knowledge

16. U.S. Residency Setting ACGME Outcome Project
In response to consumer demands
Six Competencies required
Implemented 2003, enforced 2006
All residency programs, all medical specialties
Interpret, implement, evaluate, document
Accreditation Council for Grad Medical Education

17. Six Competencies 1. Patient care: compassionate, effective
2. Medical knowledge
3. Practice-based learning and improvement
4. Interpersonal and communication skills
5. Professionalism
6. Systems-based practice

18. #5: Professionalism As manifested through:
I. Commitment to carrying out
professional responsibilities
II. Adherence to ethical principles
III. Sensitivity to diverse patient populations

19. I. Responsibilities 1. Respect, compassion and integrity
2. Responsiveness to the needs of patients and
society that supercedes self-interest
3. Accountability to patients, society, and the
profession
4. Commitment to excellence and on-going
professional development

20. II. Ethical principles
Must demonstrate commitment to ethical principles pertaining to:
1. Provision or withholding of clinical care
2. Confidentiality of patient information
3. Informed consent
4. Business practices

21. III. Sensitivity
Must demonstrate sensitivity and responsiveness to patients’
Culture
Age
Gender
Disabilities

22. Local Policies State Board County Hospital District
Family Medicine Department

23. Example: Resident Contract
Incorporates ACGME Competencies
1. Patient care
Transfers, referral, documentation
2. Medical knowledge
Rotations, exams
3. Practice-based learning & improvement
Lectures, QI, supervision of lower levels

24. Contract (Continued) 4. Interpersonal and communication skills
Patients, peers, team, staff, advisor
5. Professionalism:
Confidentiality, honesty, respect
Personal mental health
6. Systems-based practice
Completion of records, assignments

25. Family Medicine Department
Expectations
Respect, timeliness, notification, sign-outs, pages, reporting questionable conduct, personal property, rotation evaluations, attendance
Formal process for investigation of conduct
Institutional Committees

26. Summary
Professionalism has historically been an expectation in medicine.
Now: The public demands accountability.
State medical boards are under pressure.
Must measure and document competence.
Our Program has policies and procedures for addressing professionalism.

27. Example: Professional Improvement Plan
Recall the JCAHO Alert
“Rude language and hostile behavior threaten patient safety and quality of care.”
Targeted behavior: “Angry outbursts”
Process: Educate, Monitor, Enforce, Support
Written Behavioral Plan with specific:
1. Professional requirements (educate)
2. Behavioral expectations (monitor, support)
3. Predetermined consequences (enforce)

28. “Outbursts”: Implement Plan
GOAL: Learn to manage your emotions.
Strategies: Emotional intelligence coaching and/or Cognitive Behavioral methods
1. Identify situations which have the
potential for triggering your outbursts.
2. Learn and practice strategies to control
your emotions in those situations.

29. “Outbursts”: Expectations
Specific Requirements:
1. No angry outbursts for 90 days
2. Keep a log of situations in which you
controlled/prevented your outbursts.
3. Submit your completed log every 30 days.
4. Self-report if you have an outburst.
Prior to someone else reporting it.

30. “Outbursts”: Consequences
If learning contract expectations are not met
1. Review and revise the contract.
2. Consider psychological counseling.
3. Implement the new plan.

31. When is an event is reportable?
If the unmet expectation:
Endangered a patient
May endanger a patient in the future
Was reported by an agency or department that requires a response
Performance objectives are still not met after a second PIP attempt

32. SUMMARY
Professionalism has historically been an expectation for physicians.
Now: The public is demanding accountability.
State Medical Boards are under pressure.
In residency programs, professionalism must be defined, “taught,” measured and documented.
The goal is education, not punishment.

33. Is PROFESSIONALISM the basis of medicine’s contract with society?
THE END
Is PROFESSIONALISM the basis of medicine’s contract with society?