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Random Acts of Medical Professionalism
I have been mulling over the concept of recognizing random acts of professionalism for years – honest! I cannot believe that lawyers from the Washington State Bar Association beat me to it.
“Professionalism may not be sufficient to drive the profound and far-reaching changes needed in the U.S. health care system, but without it, the health care enterprise is lost.”
I find myself drawn time and again to this prescient quote from an important and timely JAMA article by Cara Lesser, Catherine Lucey and colleagues. There has never been a time in our history so desperate for medical leadership and rampant professionalism. When the article was first published, I sent the PDF to all of my faculty colleagues at Penn State College of Medicine; it received more positive comments than anything else shared from my office over the past decade. I got the sense that most people felt as I did: While we all considered ourselves professional and sincerely desired to be stellar role models to our students and residents, we would be hard-pressed to list five random acts of professionalism committed in a given week. Rarely did we spontaneously celebrate such acts when witnessed.
When Secretary of Health and Human Services Kathleen Sebelius and Attorney General Eric Holder toured the county last year speaking out against fraud and abuse in government health care programs, Ms. Lesser graciously agreed to allow me to use concepts from the article in my comments as a panelist for the Philadelphia conversation. The gist of what I shared was that, although most physicians are well-intentioned and honorable, the convoluted, complex and often indecipherable rules by which we must meet the needs of our patients and justify compensation for our services “aids and abets true criminals and tortures the rest of us.” We simply want to do what is right by our patients and have that be the path of least resistance in our harried and hectic professional lives.
The literature on medical professionalism is as old as… well, the profession itself. Professionalism is derived from the Latin, professio, to declare publicly. Formal definitions of professionalism, while lofty and generally noncontroversial regarding what we should profess – integrity, altruism, compassion, self-regulation – tend toward the abstract. They have always left me asking for more substantive and actionable examples. Lesser and Lucey provide this. Their message is that professionalism can and must be translated into action, both for individuals and institutions. They provide concrete, actionable and most important, teachable examples. I was attempting to do the same in a recent whimsical, but sincere, post on parsimonious care.
With the recent announcement from the Accreditation Council for Graduate Medical Education (ACGME) of the Next Accreditation System (NAS) for residency programs, we may be at a tipping point. To maintain accreditation, residency training programs will need to translate the core competencies into general and discipline-specific observable behaviors. For example, with respect to professionalism, how did a resident “develop and apply a consistent and appropriate approach to evaluating care, possible barriers and strategies to intervene that consistently prioritizes the patient’s best interest in all relationships and situations?” Rather than simply feeling empathetic toward the poor soul whose diabetes is out of control for lack of money and/or stability in his life, the “professional in action” lines up social services and a care coordinator to help out.
Choosing Wisely provides us with numerous additional examples of how we can translate the abstraction of professionalism into observable, measurable and teachable moments. The ABIM Foundation, collaborating specialty societies and numerous other supporters should be commended for this campaign. Kudos also to the ACP and Consumer Reports on their efforts to educate our patients regarding “high-value care.” There should be very few “aha moments” for well-informed and up-to-date physicians in these recommendations. However, they provide numerous and very specific scenarios where we can educate our patients, students and the general public about the tremendous waste and potential harm perpetrated by old habits, outmoded thinking and misaligned financial incentives.
We may someday be forced to ration high-value health care services in the U.S. by some mechanism other than lack of insurance coverage. We can postpone that day of reckoning by providing, teaching and rewarding more rational practices and making our random acts of medical professionalism a way of life.
Michael Weitekamp, MD, MHA, FACP is a Professor of Medicine at Penn State College of Medicine and a Robert G. Petersdorf Scholar at the Association of American Medical Colleges. He blogs at Wing of Zock, and can be reached at firstname.lastname@example.org.
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