A friend of mine spent some time at our hospital with his child who required medical and surgical care. The child was eventually discharged after successful treatment, but my nonmedical friend hinted to me that there was some controversy over the course of treatment, and differing caregivers opined frequently about what they felt would be the best options. That is all well and good; we all know well the aphorism involving a cat and its skin, but my friend’s concern was in the delivery and communication of the opinions. And it seemed that this component of his family’s hospital experience, even more than the health care itself, was what he remembered most vividly.
In this era of family- and patient-centred care, complex health care communication in front of the patient occurs in many directions—not just between physician and patient (or patient’s family), but also among nursing staff, paramedical staff, teaching hospital house staff, and other consulting colleagues. With all these interactions taking place, messages, plans, and opinions are seldom delivered clearly or face to face. The right hand may not understand or approve of the skill, timing, or judgment of the left hand, and this not-so-positive impression may be passed on to the patient in a way that is not flattering to either hand.
That’s where professionalism comes in.
Merriam-Webster’s Dictionary defines professionalism as “… the skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well.” Canmeds gives the medical spin on it: “As professionals, physicians are committed to the health and well-being of individuals and society through ethical practice, profession-led regulation, and high personal standards of behavior.”
It is difficult to pinpoint when professionalism actually happens—unfortunately, it is much easier to recognize its absence when it is not happening. A recent BCMA policy paper on medical professionalism takes 44 pages to attempt to provide adequate guidelines and even after reading it, it’s still pretty ethereal to me.
Some people express professionalism quite effortlessly. Their demean-or and style of communication fits the profile of a caring and effective communicator and colleague. If we can create situations where our young colleagues and trainees are exposed mostly to this type of behavior, and the professionalism component can be pointed out, that may be the best opportunity for the next generation to model it. However, teaching situations where this can occur are fewer and farther between these days, and students can’t learn professional behavior from books or screens.
It seems our society is moving away from prioritizing politeness, timeliness, and face-to-face interaction, and on top of this, our medical trainees are often pushed and pulled in too many directions to spend extra minutes absorbing a professional vibe. We may send them into patient rooms independently, without first modeling what should be done. We may complain to them, often casually or with mild derogatory humor, about a colleague or colleague’s opinion in an attempt to inflate our own. We may speak about patients or their families (or administration) in a less-than-flattering light in front of residents. We may model poor time management, brush off meetings, procrastinate filling out forms for patients or students, not keep up with medical records, or keep people waiting longer than necessary.
I am listing these behaviors because I know I have been guilty of all of them, even though I really try to be professional and am aware of my role in a teaching hospital. Putting this in writing is actually clarifying a lot of my own bad habits to me, and I realize that I probably owe many of my students, patients, and colleagues a professional apology and a promise to improve. Our young colleagues only have so much time to be with us, and if we send them a signal that these unprofessional activities are normal, these behaviors may be all they have to model. This morning a colleague sent me a cartoon out of the blue with a quote from Robert Fulghum: “Don’t worry that your children never listen to you; worry that they are always watching you.” Maybe we could turn that worry around and make the watching worthwhile.
1. BC Medical Association. Working together: An exploration of professional relationships in medicine. Accessed 6 November 2013. www.bcma.org/files/BCMA_Policy_Paper_Med_Prof_FINAL_WEB.pdf.
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