As Bob Dylan sang so memorably, “The times, they are a-changin’.” Our profession faces a much different landscape now than it did just a decade ago. If we do not change with this landscape, we risk becoming marginalized as a profession (or to follow Bob, the order that’s rapidly fading).
This is an era in which patients are more informed than ever before, want to be partners in their own care, and are far more empowered. In this day of physician shortages, they need to be. This is a good thing. Health authorities have been taking a more authoritative role and, rather than consulting with physicians, have been more inclined to dictate to them. As well, other health care providers are stepping in and wanting to assume functions that physicians have traditionally controlled.
As a profession we are not immune to these changes. To remain a profession of influence we physicians need to expand and deepen our leadership in quality care, and that includes professionalism.
All initiatives developed to improve quality care and outcomes in the health system have as their starting point some understanding of what is meant by the word quality. Without this understanding, it would be impossible to design the interventions and measures used to improve results. The lens that Doctors of BC uses when developing initiatives for its collaborative programs is based on the triple aim:
• Is it going to improve the health of the population?
• Does it improve the experience of care of the patient and of the provider?
• Is it cost-effective? Is it sustainable?
As a doctor, every one of us should invest in quality care because providing quality is the:
• Foundation of our profession.
• Source of our professional satisfaction and pride.
• Source of our professional influence.
When we deliver quality care to our patients we maintain our professional pride, we increase our professional influence, and in turn we achieve our professional goals.
During my years on the GP Services Committee, the quality care initiatives we developed had positive impacts on patient care and offered positive changes for the primary care system. With the initiative came a dramatic rise in professional satisfaction and pride, directly related to doctors being able to champion quality improvement.
But quality care goes far deeper than broad, sweeping system-wide or association-driven initiatives. It starts with our interactions with our patients: the individual, one-on-one interactions that affect important aspects of our patients’ lives. Our patients are the focus. Our patients are the foundation of quality care.
As an association of doctors, we must deepen and expand our leadership in quality care, and this can’t be accomplished without professionalism. Professionalism encompasses the attitudes, skills and behaviors, and attributes and values that are expected from those to whom society has extended the privilege of being considered a professional.
In medicine, professionalism is about building and maintaining relationships–with patients, administrators, and with colleagues–as we strive to provide quality patient care.
On a system level, shifts in health care, including advances in technology and pressures in health care funding, are making it more challenging for doctors to meet expectations around professionalism. Doctors of BC is implementing a number of initiatives to resolve these shifts that involve working with health authorities to create an environment that promotes professional working relationships.
But it is on an individual level, where doctors have dozens of contacts with patients every day, that our physician leadership abilities and professionalism can take the forefront and we can make a meaningful difference.
Patients are becoming more involved with their own health care, and their expectations of quality care are changing. Convenience, availability, and good and attentive services are expectations to be met. I believe that our foundation of influence is patient care. It all rests on that foundation—and that foundation had better be strong.
In choosing to uphold the virtues of professionalism and by holding one another accountable, doctors can enhance their professional satisfaction and the patient experience, and provide the highest standard of health care.
That is what our profession is truly about.
—Bill Cavers, MD
Doctors of BC President
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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