Professionalism Lecture 5-22-15

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Professionalism and the PhysicianMelinda Weiss, DOOGME-2May 22, 20151At the end of this presentation, listeners will be able to:Identify specific behaviors that represent elements of professionalism Recognize barriers that may impede professionalismDiscuss challenges in workplace and medical professionalism and identify possible solutions2

3So... what is professionalism?4

5American Osteopathic Association"Although ethics and professionalism encompass broad concepts, some of the recognized elements are:"Non-maleficence first, do no harmActing as a positive role modelDisplaying respect in interactions with othersLegal and ethical behavior6AOA continuedAppropriate management of potential conflicts of interestBeneficence a physician should act in the best interest of the patient/altruism/placing the needs of the patient firstAutonomy the patient has the right to refuse or choose their treatmentDignity the patient (and the medical professional involved with their care) has the right to dignity, truthfulness and honestyParticipation in self-evaluation programs and acceptance of constructive criticism from others.

ACGMEDemonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Expected to demonstrate:Compassion, integrity, and respect for others Responsiveness to patient needs that supersedes self- interest Respect for patient privacy and autonomy Accountability to patients, society and the profession Sensitivity and responsiveness to a diverse patient population

8Medical Professionalism in the New Millennium (ABIM, ACP, European Federation of Internal Medicine)Fundamental principlesPatient welfare - dedication to serving the interest of the patient. Altruism contributes to central trust in physician-patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle. Patient autonomy - Physicians must have respect for patient autonomy, must be honest with patients and empower them to make informed decisions about treatment. Patients decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care. Social justice The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.9Words most commonly associated with professionalism

Click to add textABIM, Medical Professionalism in the New Millennium: A Physician Charter, 2002Click to add text10US Department of LaborResponsibilityIntegrityAccountabilityExcellenceCommunicationTeam orientedCritical thinking11Dimensions of Professional BehaviorStandardContemporaryAltruismAccountabilityCommitment and self-reflectionCompassion and sensitivityIntegrityRespectTeamworkCultural awarenessCommunity responsibilityLifelong learningSocial networkingHIPAA12

13What is professionalism?Medical professionalismWorkplace professionalism respect for patient autonomyethicscompassionintegrity

maturityresponsibility/accountabilitycompetencerespectfulintegrityOVERLAP!14How is professionalism judged?15How is professionalism judged?against expectations or standardssituationalinfluenced by cultureyour actions:communicationimagecompetencedemeanor"Unprofessional" - contrary to the accepted code of conduct for a profession16Generation Gap?Peer group defined by both its demographics and its key life events. Because of similar influences and experiences, individuals within a generational cohort are likely to possess shared values and behaviors. Borges NJ et al. Acad Med 2006.17What is unprofessional?What is unprofessional?Intellectual/personal dishonestyArrogance/disrespectfulnessPrejudiceAbrasive interactionsLack of accountabilityFiscal irresponsibilityLack of sustained commitment to self learning/improvementLack of due diligence lazinessPersonal excess substance abuse, gamblingSexual misconductDuff, 2004Barriers

20BarriersPersonal or professional cultureLack of clear goals/expectationsApathyInexperiencePersonal issuesConflictEconomicsLoyaltyImageCompetenceDemeanorHuman natureLack of role models/examples

Residents Perceptions of Barriers169 IM, neurology, FP residents surveyedBiggest 3 barriers:Time constraintsWorkload/overworkedDifficult patientsSolutions

23SolutionsRole modelsOpen communicationRoleplaying scenariosClear expectations

what else?

24WWYDYou are an intern on a rotation where you and 2 other residents are responsible for rounding on all patients in the morning. You have 24 patients on your census. The night before, one of these residents texts you and says Hi, I wont be rounding because this is an off service rotation for me, and I didnt operate on these patients, so theres no need to see them.

What would you do?25WWYDOne of your co-residents is showing up 10 minutes late every day. He looks exhausted and says I just cant seem to get here on time, silly me! You have been picking up his work for the last week but you are fed up.

What would you do?26Questions?

ReferencesABIM Foundation. American Board of Internal Medicine; ACP-ASIM Foundation. American College of Physicians-American Society of Internal Medicine; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med2002;136:243 6.Duff, Patrick. Teaching and assessing professionalism in medicine. Obstetrics and Gynecology.104(6):1362-6.2004. N Ratanawongsa, et al. Residents Perceptions of Professionalism in Training and Practice: Barriers, Promoters, and Duty Hour Requirements. J Gen Intern Med.2006 Jul;21(7):758-63.Papadakis MA, Hodgson CS, Teherani A, Kohatsu ND. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med 2004;79:244 9.Task force report part II: barriers to professionalism. https://www.wisconsinmedicalsociety.org/_WMS/publications/wmj/pdf/102/2/8.pdf.