|
 
 |
| EDITORIAL |
|
| Year : 2022 | Volume
: 24
| Issue : 3 | Page : 3-4 |
|
Professionalism in clinical practice
Subhash Chandra Shaw1, Anuj Singhal2
1 Department of Paediatrics, Army Hospital Research and Referral, New Delhi, India
2 Department of Internal Medicine, Army Hospital Research and Referral, New Delhi, India
| Date of Submission | 11-Apr-2022 |
| Date of Decision | 12-Apr-2022 |
| Date of Acceptance | 13-Apr-2022 |
| Date of Web Publication | 01-Jul-2022 |
Correspondence Address:
Surg Capt (Dr) Anuj Singhal
Department of Internal Medicine, Army Hospital Research and Referral, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jmms.jmms_59_22
How to cite this article:
Shaw SC, Singhal A. Professionalism in clinical practice. J Mar Med Soc 2022;24, Suppl S1:3-4 |
“The physician needs a clear head and a kind heart; his work is arduous and complex, requiring the exercise of the very highest faculties of the mind, while constantly appealing to the emotions and finer feelings.”
– William Osler[1]
| What Is Professionalism in Clinical Practice? | |  |
Medical professionalism is exemplified through what physicians actually do and how they perform responsibilities to individual patients and their families. Professionalism is a core competency for physicians, and the physicians are expected to consistently demonstrate professional behaviors in diverse situations, depicting the values of professionalism. The professional values include noncognitive skills, such as communication including empathy, integrity, language, and compassion; collaboration including respect, duty, and responsibility; and finally, sustained improvement (recognition of limitations and motivation to improve).[2] Professionalism is not one time acquired attribute, and it requires commitment, lifelong learning, and practice. However, are we really mindful of these professional behaviors in day-to-day or routine professional life?
| Why Is Professionalism so Important for a Clinician? | | |
The primary rationale for professionalism is to enhance patient outcomes and his/her safety. Health-care delivery by professionals needs to communicate well, respecting the principles of honesty, respect for others, confidentiality, and responsibility for their actions. Professionalism is the basis of why a patient seeks a doctor, and it is a type of unwritten contract between doctor and patient. It requires placing the interests of patients above those of the clinicians and setting and maintaining high standards to provide expert advice to clientele.
| What Are the Principles of Professionalism in Health Care? | | |
There are three principles, namely, principle of patient welfare, patient autonomy, and social justice. The patient welfare focuses on altruism, trust, and patient interest. Autonomy provides honesty with patients and the need to educate them to make appropriate medical decisions. Social justice is based on distributive justice where the needs of all patients are taken care of when taking care of an individual patient keeping availability of resources in mind.[2]
| What Are the Attributes of Professionalism Required for a Clinician? | | |
Humility is the most important and valuable attribute of a professional. A humble person would acknowledge the mistakes accepting criticism graciously and would tender apology if need be. At times, the most brilliant among us are not liked by our colleagues and subordinates because of our inability to acknowledge and appreciate the other team members. The other desirable professional attributes include altruism, servant leadership, accountability, responsibility, honesty, reliability, compassion, respectfulness to colleagues and patients, loyalty, tactfulness, and sensitivity.[3] Altruism is nothing but unselfish concern for the welfare of others, superseding self-interest without any expectations of reward. Maintaining a delicate balance between one's altruistic tendencies, family life, and own mental health is the key. Next is servant leadership. Servant leader, according to Greenleaf, is the one who begins with the natural feeling that one wants to serve and to serve first. Then comes the conscious choice for one to aspire to lead.[4] Compassion (response to suffering that involves a motivation to relieve that suffering) is often regarded as fundamental to effective clinical practice. Compassion is acting with warmth and empathy, providing individualized care, and acting in such a way that you would like others to act toward you.[5] Sensitivity toward patients is another necessary quality that every clinician should possess and so is communication skills, particularly delivering bad news.
| How to Inculcate Professionalism in Budding Clinicians? | | |
The attributes of professionalism can be worked upon. Simple changes in attitude such as saying “please” and “thank you” more often, expressing gratitude to team members, learning names of the team members, and treating them with respect go a long way in fostering mutual respect and collegiality.[6]
Empathizing with the patients is important, and guiding them beyond the requirements of duty is an achievable aspect of altruism. Simple day-to-day acts of kindness, helping patients according to individual capacity, consciously training oneself for altruism, establishing teamwork and enforcing altruism by the system rather than an individual, generating funds to help a needy patient, realizing limitations, and being mentally ready for the extra stress are the way forward in ensuring practice of altruism.[7]
A servant leader would always share power, put the needs of others first, and help individuals develop and optimize performance. A servant leader would be willing to learn from others in the team and forsakes personal advancement and rewards. These leaders focus on day-to-day coaching, performance planning, and helping people achieve. The goal of a servant leader ultimately is the investment of the leader's life in the lives of those who follow.[8]
Skills essential for providing compassionate care are getting to know the patient, demonstrating respect, putting oneself in the “shoes of the patients,” having a genuine sense of care for the patient, feeling the patient's suffering and willingness to provide support, identifying with and liking patients, and eventually acting in the best interest of the patients. Compassion is conveyed to the patients by attentive mindful listening, making eye contact, smiling, posture and body language, tactile contact, small acts of kindness, and conveying a sense of acknowledgment and understanding.[9]
One should be able to demonstrate sensitivity and responsiveness to patients' culture, gender, age, and disabilities. Many challenging interactions do arise between doctors and patients due to discrepancies in either expectation or perception and/or communication. The communication with patients must contain 7 “C”s, namely Clear, Concise, Concrete (to the point), Correct, Coherent, Complete, and Courteous. A few examples of challenging situations are when the patient presents a long list of symptoms, when the patients feel that they are not being listened to, there is no diagnosis found despite extensive workup, delivering bad news without ensuring appropriate settings, delivering difficult news without showing empathy, or when a patient threatens legal action or reports in social media. Some tips to circumvent such situations are looking for signs of distress or anger in patients, plan in advance how best to deliver a difficult or bad news by structuring the thoughts, provide your patients' ways to access further support, keep the information to patients simple without medical jargons, pay attention to nonverbal communication, try to find common ground, upgrade your own knowledge and seek additional training if need be, and help your patient get emotional control.[10]
In the end, we need to create a culture in which service and sacrifice will be valued more than fame and success. In clinical practice, all the essential attributes such as humility, servant leadership, lifelong learning, altruism, kindness, responsibility, sensitivity and concern for patient safety, integrity, self-regulation, and honesty would need to be practiced over a lifetime. Teaching professionalism and inculcating professional values and attributes is an indispensable part of the teaching and training of clinicians. Societal values have changed and there are increasing challenges which needs to be addressed by clinicians, which can be achieved only when professionalism be “taught” besides being “caught.” As stated by Jordan Cohen, President of the Association of American Medical Colleges, “The physician professional is defined not only by what he or she must know and do, but most importantly by a profound sense of what the physician must be,” we need to “walk the walk and talk the talk” and practice what we preach.[11]
| References | | |
| 1. | Osler W. Teaching and thinking. In: Aequanimitas, with Other Addresses to Medical Students, Nurses and Practitioners of Medicine. New York: McGraw-Hill Book Company; 1906. p. 117-29.  |
| 2. | Kirk LM. Professionalism in medicine: Definitions and considerations for teaching. Proc (Bayl Univ Med Cent) 2007;20:13-6. |
| 3. | Duff P. Teaching and assessing professionalism in medicine. Obstet Gynecol 2004;104:1362-6. |
| 4. | Greenleaf RK. Servant Leadership – A Journey into the Nature of Legitimate Power and Greatness. Costa Mesa, CA: Paulist Press; 1977. |
| 5. | Bray L, O'Brien MR, Kirton J, Zubairu K, Christiansen A. The role of professional education in developing compassionate practitioners: A mixed methods study exploring the perceptions of health professionals and pre-registration students. Nurse Educ Today 2014;34:480-6. |
| 6. | Chestnut DH. On the road to professionalism. Anesthesiology 2017;126:780-6. |
| 7. | Sajjad M, Qayyum S, Iltaf S, Khan RA. 'The best interest of patients, not self-interest': How clinicians understand altruism. BMC Med Educ 2021;21:477. |
| 8. | Allen GP, Moore WM, Moser LR, Neill KK, Sambamoorthi U, Bell HS. The role of servant leadership and transformational leadership in academic pharmacy. Am J Pharm Educ 2016;80:113. |
| 9. | Sinclair S, Norris JM, McConnell SJ, Chochinov HM, Hack TF, Hagen NA, et al. Compassion: A scoping review of the healthcare literature. BMC Palliat Care 2016;15:6. |
| 10. | Hardavella G, Aamli-Gaagnat A, Frille A, Saad N, Niculescu A, Powell P. Top tips to deal with challenging situations: Doctor-patient interactions. Breathe (Sheff) 2017;13:129-35. |
| 11. | |
|
Search Pubmed for