Re: Professionalism: Are we passing on our bad habits?

I greatly appreciated Dr Verchere’s thoughtful article on professionalism (BCMJ 2013;55:454,461). It made me wonder how we develop professionalism—I think of the teachers I had in medical school, the senior members of my general practice group, and the teachers I had during my psychiatry residency. They all lived the role of professional physicians and teachers—mindful of ethics, skill, and the privilege of caring for patients and earning their respect. 

It seems germane to recall that prior to the introduction of medicare doctors were taught it was unprofessional to discuss or broker fees, engage in business, or accept gifts—especially money. Boundaries in our relationships with patients were clearly defined. I recall how older doctors took care to discuss boundary issues with younger doctors and impart that value system.

Today, information is easily transmittable via the Internet or a hand-held electronic device, but values, boundaries, and responsibilities are not imparted during that information exchange.

There are inherent complexities in our multicultural society with its many competing values, all of which affect the practice of medicine and delivery of health care. For example, some doctors choose not to take bookings for appointments but instead ask patients to drop in and wait their turn. Some recent graduates have an approach to practice that emphasizes a life-work balance and they strive for a 40-hour work week. In my community many psychiatry graduates choose to work sessional hours at hospital or government clinics to avoid the expenses of office, on-call, and even full-time practice. The shortage of general practitioners has led to the proliferation of drop-in clinics where acute care is more readily available but where many patients cannot find a GP for their families. The private clinics that have arisen promise rapid response for acute medical and surgical treatment but require payment for the service plus a monetary premium to join the clinic and receive the enhanced care.

I wonder if professionalism is being diluted or sidelined in this sped-up, pragmatic culture, and if the pervasive influence of government priorities (consider the embattled emergency departments in our hospitals) adds to this erosion. I have observed budget cutbacks across our nation, causing reduced access to care, rejection of patients with complex multiple disorders (some clinics post signs declaring that a patient may only present with one problem), and some specialists not being able to find work—general surgeons, for example. I know a locally born young man who did not get accepted into a local medical school but was promptly accepted into medical school in Australia. He has now graduated and is beginning his internship there. He says he has little chance of finding a way to enter practice in BC and will likely enter practice in Australia or seek a residency in a specialty there. He is one of a few dozen BC-born in the same situation in Australia.

As a further example of my concerns, I am a psychiatrist contemplating retirement, but I worry that my patients will have difficulty finding psychiatric treatment, and the special inpatient program I work in has not found a replacement for me in several years of advertising and recruiting.

Musings at the end of a 10-hour day.
—James Quan, MD
Vancouver