1. Professionalism Paul Dassow, MD, MSPH MD 815 November 15, 2006

2. Objectives 1. Know the definition of Professionalism and be able to discuss its application to medicine 2. Be (very) familiar with the Hippocratic Oath and the Oath of Professionalism 3. Recognize the barriers to professionalism in today's environment

3. Professionalism – What is it? A profession – an occupation which requires all those doing similar work to agree to (profess) a standard and required set of behaviors. This is typically self regulated. Professionalism – exhibiting those behaviors that have been professed in a consistent and persistent manner.

4. The 6 ACGME Competencies Medical Knowledge Patient Car Interpersonal Communication Skills Life-long learning Systems based practice Professionalism

5. Oath taking and Professionalism Oath: A formal declaration or promise to fulfill a pledge, often calling upon God or some other sacred object as witness

6. For Physicians The Original Hippocratic Oath The Modern Hippocratic Oath The Oath of Professionalism

7. Oaths in Medical School Drs. Orr and Pang studied oath taking in Med schools and found 1 : –1993: 98% of schools administered some Oath 1928: Only 26% of schools required an Oath –68 schools used versions of the Hippocratic Oath Only 1 school used the original version –Of the Oaths currently being used: 100% vow commitment to patients Only 43% vow accountability for their actions 14% include a prohibition against euthanasia Only 3% prohibit sexual contact with patients 1. Orr RD, Pang N. The Use of the Hippocratic Oath: A review of 20 th Century Practice.

8. Going back to our Roots The Hippocratic Oath –Attributed to Hippocrates –Circa 400 BC –Established a set of behaviors felt to be essential for those practicing the art and science of Medicine –Accepted by the Medical profession for over 2 millennia with little fanfare

9. The Hippocratic Oath I swear in the presence of the Almighty and before my family, my teachers and my peers that according to my ability and judgment I will keep this Oath and Stipulation.

10. The Hippocratic Oath To reckon all who have taught me this art equally dear to me as my parents and in the same spirit and dedication to impart a knowledge of the art of medicine to others. I will continue with diligence to keep abreast of advances in medicine. I will treat without exception all who seek my ministrations, so long as the treatment of others is no compromised thereby, and will seek the counsel of particularly skilled physicians where indicated for the benefit of my patient.

11. The Hippocratic Oath I will follow that method of treatment which according to my ability and judgment, I consider for the benefit of my patient and abstain from whatever is harmful or mischievous. I will neither prescribe nor administer a lethal dose of medicine to any patient even if asked nor counsel any such thing. I will hold the utmost respect for every human life from fertilization to natural death and reject abortion that deliberately takes a unique human life.

12. The Hippocratic Oath With purity, holiness, and beneficence I will pass my life and practice my art. Except for the prudent correction of an imminent danger, I will neither treat any patient nor carry out any research on any human being with the valid informed consent of the subject or the appropriate legal protector thereof, understanding that research must have as its purpose the furtherance of the health of that individual.

13. The Hippocratic Oath Into whatever patient setting I enter, I will go for the benefit of the sick and will abstain from every voluntary act of mischief or corruption and further from the seduction of any patient. Whatever in connection with my professional practice or not in connection with it I may see or hear in the lives of my patients which ought not be spoken abroad, I will not divulge, reckoning that all such should be kept secret.

14. The Hippocratic Oath While I continue to keep this Oath unviolated may it be granted to me to enjoy life and the practice of the art and science of medicine with the blessing of the Almighty and respected by my peers and society, but should I trespass and violate this Oath, may the reverse be my lot.

15. Summary Respect for teachers and teaching Maintain clinical excellence Treat all who seek help Pledge of beneficence Refrain from taking life Do not violate patient's autonomy Patient confidentiality Penalty for breaking oath

16. The Pledge of Professionalism

17. The pledge of professionalism I do solemnly promise to uphold the following pledge as I enter my chosen profession. To conduct myself in an honest and courteous way as a socially responsible citizen of my class, our college, our community, our nation and our world.

18. The pledge of professionalism To develop and nurture habits of life-long learning and maintain current knowledge and expertise. To do my utmost to foster the success of my colleagues and earn the respect of my peers, my faculty, and my patients. To relate to my peers, faculty, patients, and their families with truthfulness and respect.

19. The pledge of professionalism To choose my role models carefully and strive to become an inspirational role model for future generations. To hold sacred privileged information from both patients and colleagues and honor their trust by preserving confidentiality. To accept inconveniences and endure unavoidable personal risk in order to further my education and meet the needs of my patients.

20. The pledge of professionalism To advocate for care regardless of ability to pay. To value the quality of life and to cherish the privilege of trust granted to me by patients and their families, and to always serve the best interests of our patients.

21. So, what professional characteristics (virtues) did you pledge? Honesty Social responsibility Maintain excellent clinical skills Respect patients and colleagues Confidentiality Advocate care for all Beneficence Respect for teachers and teaching Maintain clinical excellence Treat all who seek help Pledge of beneficence Refrain from taking life Do not violate patient's autonomy Patient confidentiality Penalty for breaking oath

22. Threats to Professionalism

23. Threats to professionalism The culture of medicine Becoming casual with your words The temptation of power and power differentials Money Loss of self regulation (personal and professional)

24. The Unspoken Contract Patients enter a room with a physician and expect: –Clinical competence –Privacy –Respect –Beneficence –Safety

25. Breaking the Contract Loss of respect and honor for the profession Loss of the patient Legal remedies –Negligence (clinical competence) –Breaches in Professionalism HIPPA – Health Insurance Portability and Privacy Act

26. Keeping your priorities in line Have a “community of physicians” conscience –You do have a responsibility to report unprofessional behavior Be aware of the threats and actively work to thwart them Be responsible with $$ Remember, Remember, Remember –Why you became a physician –Your Oaths –Your responsibility to society

27. My Story