Professionalism, and the seven year ache

I spent the first few years of the 2010s doing research on disruptive surgeon behavior, trying to get a handle on what precisely it is and what its effects are. That work came to publication right around the same time as my first role as a Vice Chair of Education and Professionalism; when we were developing the models of disruptive behavior there was an undeniable impact on learning environment, so if I was going to be responsible for education I wanted to also have authority to address “bad behaviors” by those doing the educating.

I’m here to say I’ve learned a lot in these roles. I’m also here to say that while in 2014 I was proud to be in a leadership role addressing education and professionalism, I know also sometimes mumble the last part of that title (even though I had advocated for it). I naively thought that professionalism wasn’t a complicated concept- in my mind, it equated with creating spaces of psychological safety that positively impact both learning and patient care. Professionalism was being clear, communicating effectively and respectfully, working in ways that engender mutual support. Professionalism included exhibiting emotional intelligence and engaging in crucial conversations.

Being a Pollyanna can be such a delightful thing (and yes, if you are a student of the Enneagram, I’m VERY 7)…until it’s not.

Over time I’ve seen professionalism turned into a weapon in a couple of different ways, neither of which are helpful. In one version, the leader/ senior person uses “I was just taking care of the patient!” as their justification for behaving in a way that is decidedly not collegial. While that’s certainly logic that is hard to argue with, it’s a devious use of the concept of professionalism to focus solely on patient care through a lens of perfectionism. I’ve got no intention of diving into the psychopathology underlying perfectionism that shows up in this way, but I will say that it’s clearly intended to shame people into doing things. And, as we all know, shaming isn’t actually an effective teaching or collaboration technique.

I’ve also learned that professionalism can (and is) used against individuals who are members of historically excluded groups as a tool of conformity. Using voice and diction, hair styles, clothing choices (to name only a few options) as a basis for someone “not being professional” becomes incredibly subjective; in these cases, what it more often means is “this makes me uncomfortable because it’s not what I’m used to hearing/ seeing.” Professionalism has in many settings become an instrument of bias that is deployed by those who are traditional power-holders- and if I’m honest, it frustrates me that they choose to use it in this manner. I’ve never been a fan of power “over” relationship structures, particularly for something that is ideally a power “with” or power “to” concept.

I still believe that there is a concept out there that aligns with what I used to think professionalism was. I also still believe there can be a net benefit from systems and structures that are designed to enhance collegiality and interrupt bias. I’m just not sure what the word that describes it is anymore; perhaps it is still professionalism, and the idea needs to be reclaimed from the abuses that it has suffered.