From the Editor's Desk

Professionalism

A. Allen Seals, M.D.
Editor-in-Chief,
Jacksonville Medicine

The medical profession has long subscribed to a body of ethical statements developed primarily for the benefit of the patient. As a member of this profession, a physician must recognize responsibility to patients first and foremost, as well as to society, to other health professionals, and to self."

That's how the American Medical Association summarizes the concept of professionalism in the preamble to its Principles of Medical Ethics. The preamble points out that while these are not laws, they are vital "standards of conduct which define the essentials of honorable behavior for the physician."

The practice of medicine has historically been recognized as a profession, practiced by professionals, in a time-honored code of professional ethics. Medical educators have long touted the importance of these ethics as part of the medical curriculum. This education should be an important supplement to the physician's own well-established moral background that would allow immediate understanding and acceptance of the teachings of ethical concepts as applied to the practice of medicine. In fact, for most physicians, medical ethics is basically a confirmation of their own inherent beliefs and personal moral values—a byproduct of their own parental and religious training.

Health care is ultimately a moral enterprise, built on protecting the patient, and grounded in trust.

Unfortunately, physicians have sometimes observed other doctors who demonstrate exceptions to these principles of behavior, actions clearly outside the standards of accepted professional conduct which prove the concept that there is a "bad apple" in every bunch.

• When a doctor disregards an established physician-patient relationship and attempts to manipulate and persuade the patient by inserting himself as a "better" physician, there is a lack of professionalism.
• When a doctor performs unnecessary tests and procedures on a patient for her own financial gain, there is a lack of professionalism.
• When a doctor openly states that he is motivated by an unscrupulous concept that encourages excessive (and oftentimes unjustified) billing practices on the concept that you "eat what you can kill," there is a lack of professionalism.
• When a doctor excessively self-promotes himself to other physicians as a "superior" healthcare provider while openly demeaning other physicians, there is a lack of professionalism.

In Meno, Plato asks Socrates, "Is virtue something that can be taught? Or, does it come by practice? Or, is it neither teaching nor practice that gives it to a man but natural aptitude or something else?"

This ancient question defies an easy answer. Medical education and training not only provides medical students with a new vocabulary and a new knowledge base, but also serves as a moral pilgrimage in which character and attitudes are molded by the experience of caring for sick patients, and the opportunity to interact with fellow physicians. Not every student will emerge from the training pilgrimage with character traits that will insure ethical and professional standards are always maintained.

And unfortunately there is no gold standard to identify with precision those students whose character flaws may prevent them from developing the kind of ethical and professional attitudes that society wants and demands of its physicians. Sadly, it is undoubtedly the students who lack this moral foundation who will later exhibit the serious examples of "bad apple" behavior cited above.

Increasingly, physicians and managed care organizations are being held accountable for quality of care based on the processes and outcomes of medical care and patient satisfaction. Yet high-quality health care delivery involves more than good technical quality and customer service.

Health care is ultimately a moral enterprise, built on protecting the potential extraordinary vulnerability of patients—and grounded in a covenant of trust between patient and physician, and a covenant of professional behavior between physicians themselves. It therefore requires a shared set of expectations for ethical and professional behavior between all physicians.

But what happens when an individual ignores these ethics, and practices in a reckless manner that places her outside this "standard of professionalism"?

There is now a renewed consensus among physicians that it is our shared responsibility to protect the professionalism of our vocation by enforcing professional behavior ethics. The means of enforcement may include quality assurance committees, ethics committees, and medical boards.

It is not acceptable to shrug our shoulders, look the other way, or in other ways ignore blatantly unprofessional conduct. It is not acceptable to allow our profession to degenerate into a jungle of sleazy and unethical individual doctors driven by monetary goals determined to "eat what you kill." We must require that our medical leaders demonstrate their leadership by enforcing our own code of ethical behavior. It is time for ethical physicians to preserve our profession and the ethics of professionalism that form the fundamental basis of our profession.

Resident Research 2003 Jacksonville Medicine www . DCMS online . org

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