Trust me…I’m a professional

professionalism (noun):  the skill, good judgement, and polite behavior that is expected from a person who is trained to do a job well.

I’m the first to admit that when the ACGME included professionalism as one of the Core Competencies in 1999 that I immediately used the analogy to the 1964 Potter Stewart/ Supreme Court definition of pornography- “I know it when I see it.”  Of note, Stewart subsequently recanted his subjective view of the topic, and while I hold that it’s a terribly difficult thing to objectively evaluate in medicine, I don’t dispute the importance of doing so.

Professionalism in medicine has long been part of the “hidden curriculum,” in which trainees are not formally taught, but instead acquire knowledge, skills and attitudes through observation and experience.  The guiding assumption was that the mentors/ teachers were masters of professionalism, and therefore it would trickle down to our trainees.  Instead, what we have found (particularly with current generational changes) is that our trainees are often questioning our professionalism; they do want us to be good role models for them, certainly, but they’re also willing to ask why people who aren’t always succeeding in terms of their professionalism are allowed to criticize them for a lack of it.  It’s an interesting conundrum we’ve found ourselves in, really.

In 2002, the ABIM created a Medical Professionalism charter (surgeons:  please note that the ABS and the ACS have endorsed this charter).  While all 10 of the commitments are important, the one most of interest to me- professionally and academically– is the last:  professional responsibility.  This sentence states succinctly where I see us falling short:

“As members of a profession, physicians are expected to work collaboratively to maximize patient care, be respectful of one another, and participate in the processes of self-regulation, including remediation and discipline of members who have failed to meet professional standards.”

We know, from my work and that of others, that as surgeons we are not always respectful, and that some of us are downright disruptive in our actions.  I honestly believe that those who behave badly do have their patients’ best interests at heart, but simply have a warped view of how to act on their behalf.  While I don’t believe for a minute that anyone is disruptive simply for the sake of being disruptive, I do believe that we don’t act enough in a collegial fashion to help our colleagues who struggle with this behavior.  How do we create an environment that has zero-tolerance for being a jerk?  How do we create an environment in which “inciting events” are vanishingly rare, and in which the team and the surgeon have default ways to deal effectively and constructively with those events?  And how do we “fix” our colleagues who may have a bit of a predisposition to bad behavior, but don’t have a personality disorder underlying their actions?  In short, how do we do a better job being “our Brother’s/ Sister’s keeper”?

I’m working on the answers to these questions, and I hope I’ll eventually have something scholarly and wise to offer.  In my new role as Vice Chair of Education and Professionalism (I believe these things to be inextricably linked…more on that another day), I’m creating a Council with broad representation from the preoperative environment to decide how we can better define professionalism, how we can best reward those who do it well, and how we can support those for whom it’s not innate.  It’s time for us to have a not-so-hidden curriculum, and it’s time for us to step up and be the role models that our trainees desperately want and deserve.