Professionalism has always been an essential and foundational aspect of medicine. It is the way we tangibly express our individual and collective commitment as physicians to altruism, morality, integrity, competence, and support of the personal and public good. It also forms the basis of the social contract we have with patients and society.
Professionalism itself is associated with personal character, virtues, ethics, and humanistic principles that are reflected in the oaths we take early in our careers that provide guiding principles and expectations for all physicians. It also has a behavioral component in which our activities are assessed relative to these underlying principles and expectations, much as you’ve likely already experienced as medical students. Ultimately, professionalism becomes an essential and meaningful aspect of our personal identity formation as doctors.
However, what professionalism in medicine actually looks like in our daily lives has historically been profoundly influenced by advances in the scientific underpinnings of medicine, changes in the values of patients and society as a whole, how health care is delivered, and how we as individual physicians view our role and relationships with the patients we serve and the systems in which we work. As times and circumstances change, so do the ways in which we adhere to and express these core values and beliefs that underlie medicine.
Medical professionalism can therefore be thought of as an active, ongoing, and iterative process that each of us must constantly attend to in our personal and professional lives. As internal medicine’s seminal figure, William Osler expressed more than a century ago, “The times have changed, conditions of practice have altered and are altering rapidly, but…we find that the ideals which inspired [our predecessors] are ours today—ideals which are ever old, yet always fresh and new.”
As students, you are just now entering a new and rapidly changing world that will require that you examine closely your own professional beliefs and how you will represent them in your daily attitudes and actions. As you move through your training, you will undoubtedly experience new knowledge, clinical situations, and personal and societal pressures that will challenge your professional views and beliefs (Even how you use social media as a physician has professionalism implications!), and how you respond to them will ultimately shape the professionalism that you will carry with you throughout your career.
Therefore, it is helpful at this early point in your journey in medicine to develop the habit of constantly reminding yourself of the core principles and values that serve as the foundation of medicine and examine how you manifest them in your personal and professional life.
A good place to start is by taking a look at Medical Professionalism in the New Millennium: A Physician Charter. Although this was published nearly 20 years ago, much as Osler noted, the fundamental principles of primacy of patient welfare, patient autonomy, and social justice are timeless, as are professional commitments to:
- Professional competence
- Honesty with patients
- Patient confidentiality
- Maintaining appropriate relations with patients
- Improving quality of care
- Improving access to care
- The just distribution of finite resources
- Scientific knowledge
- Maintaining trust by managing conflicts of interest
- Our professional responsibilities
Becoming a doctor is clearly not a finite process. Rather, it is an ongoing one in which we seek to grow and develop based on the core principles and responsibilities that allow our profession to occupy such a special place in society and the lives of our patients in an effort to become the best physicians (and humans) we can be.