ABC of Clinical Professionalism

Nicola Cooper, Anna Frain, John Frain

• Publisher: Wiley-Blackwell
• Year: 2017
• ISBN:
  9781119266693
• Edition: 1
• Topic: Médecine
• Subtopic: Médecine clinique

Clinical professionalism is a set of values, behaviours and relationships which underpins the public's trust in healthcare providers both as individuals and organisations. 'First, do no harm' is expressed most clearly today in the patient safety movement and the imperative for transparency and candour in the delivery of healthcare. Professional conduct is essential for safe and high quality clinical care.

The ABC of Clinical Professionalism considers recent evidence on how healthcare practitioners maintain professionalism including how values are developed and affected by the working environment, the challenges of maintaining personal and organisational resilience and the ethical and regulatory framework in which practice is conducted. Topics covered include:

• Acquiring and developing professional values
• Patient-centred care
• Burnout and resilience
• Confidentiality and social media
• The culture of healthcare
• Ensuring patient safety
• Leadership and collaboration
• Ethical and legal aspects of professionalism
• Teaching and assessing professionalism
• Regulation of healthcare professionals

The chapter authors come from a range of countries and have experience of working in multidisciplinary clinical teams, research, and in the training of future healthcare practitioners including their development as professionals.

Chapter 1
Why Clinical Professionalism Matters

John Frain

Division of Medical Sciences and Graduate Entry Medicine,, University of Nottingham, UK

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OVERVIEW

• Clinical professionalism is founded on respect for the dignity of each human person.
• Each health professional, health service provider, professional body and regulator should ‘first, do no harm’ to those in their care.
• Modern professionalism is a partnership of patient and professional in an organisational framework that supports the safety and well-being of both parties.
• A duty of care acts to protect patients from a potentially unequal relationship with healthcare providers and professionals.
• A culture of rudeness and incivility in healthcare fosters cynicism and burnout in healthcare professionals and damages patient care.
• Clinical professionalism underpins safe patient care and addresses the human factors that contribute to clinical errors.

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Introduction

We are all human beings. We share the same human condition – we suffer, make mistakes, we fall away from our ideals. Equally, we are all capable of greatness, of excellence and of placing the needs of others above ourselves. Each of us is unique and has a value which can never be ignored or taken away. Our roles in life should not only occupy our time but engage and bring us satisfaction. The ancient Greeks defined true happiness as the full use of one's powers along lines of excellence (see Box 1.1). These concepts have been espoused from ancient times.

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Box 1.1 An ancient Greek definition of happiness.

‘The good of man is the active exercise of his soul’s faculties in conformity

with excellence or virtue, or if there be several human excellences or virtues,

in conformity with the best and most perfect among them'.

Aristotle (384–322 BCE), Nicomachean Ethics

This was paraphrased by John F. Kennedy as, ‘Happiness is the full use of your powers along lines of excellence in a life affording scope’.

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We collaborate in communities and societies because it is in our interest and that of our group, because there is a mutual benefit in doing so. Some of us seek to alleviate suffering, to repair others and to improve and extend quality of life. Intervening in the lives of others is a challenge carrying a responsibility, again recognised long ago and addressed by Hippocrates: ‘First, do no harm.’

This starting point of care by health professionals is set out more clearly in the Hippocratic Oath (see Box 5.1). While intended for the physicians of the time, the principles encapsulated in the oath are reflective of the duties of all healthcare professionals and healthcare organisations in the modern era. Though modified for various settings, their essence is essentially unchanged. In the 21st century, the Physicians' Charter, a collaboration of American and European professional bodies, is a derivative of the Hippocratic Oath rather than its replacement (see Box 1.2). In addition, regulatory bodies have developed guidance on values and practice for their own disciplines which also reflect these concepts (see Further reading/resources).

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Box 1.2 The physicians' charter.

Professionalism is the basis of medicine's contract with society.

• Fundamental principles:
  1. Principle of primacy of patient welfare.
  2. Principle of patient autonomy.
  3. Principle of social justice.
• A set of professional responsibilities:
  1. Commitment to professional competence.
  2. Commitment to honesty with patients.
  3. Commitment to patient confidentiality.
  4. Commitment to maintaining appropriate relations with patients.
  5. Commitment to improving quality of care.
  6. Commitment to improving access to care.
  7. Commitment to a just distribution of finite resources.
  8. Commitment to scientific knowledge.
  9. Commitment to maintaining trust by managing conflicts of interest.
  10. Commitment to professional responsibilities.

Adapted from ABIM Foundation, American Board of Internal Medicine, ACP-ASIM Foundation (2002) American College of Physicians-American Society of Internal Medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine, 136 (3), 243–246.

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Formation of professions and the duty of care

The concept of medicine as a ‘profession’ emerged in the late medieval period with the formation of professional guilds. Initially, the term encompassed the standards and codes of conduct of the practitioners themselves and was essentially doctor-centred. In time, the protection of medical practice from other competing professions, as well as rules governing the commercial conduct of practice, evolved the concept further. The socialisation of health services and the development of patient-centred practice in the last half-century has led to a description of professionalism as a contract between doctors and society. This contract addresses questions of funding, resource allocation and consumerism, but most importantly in ensuring that the patient's own views are heard above those of the various parties involved in healthcare. This is what Engel described as not only, ‘What was the matter with the patient’, but ‘what mattered to the patient’ [Engel, G.L. (1977) The need for a new medical model: a challenge for biomedicine. Science, 196 (4286), 129–136]. The process of healing is thus not simply the removal of disease but also the enablement of patients in achieving full use of their powers and potential (see Chapter 3).

The partnership of patient and professional has been expressed as:

Patient: I suffer; Professional: I think; Patient and Professional: We will act

(Skelton, 2002)

Even if truly patient-centred, this partnership is still potentially unequal. The patient must rely on the professional's knowledge and skills and the conscientious application of them. The patient may have insufficient expertise to adequately judge if this is the case, and so must trust his or her healthcare professional to do the right thing. In Law, this is addressed by the ‘duty of care’ (see Box 1.3). Both individuals and organisations control the means and manner of access to healthcare, and therefore both have a duty of care to their patients.

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Box 1.3 The duty of care.

‘Irrespective of any contract, i...

Table of contents

• Cover
• Title Page
• Copyright
• Table of Contents
• Contributors
• Preface
• Chapter 1: Why Clinical Professionalism Matters
• Chapter 2: Acquiring and Developing Professional Values
• Chapter 3: Patient-Centred Care
• Chapter 4: Burnout and Resilience
• Chapter 5: Confidentiality and Social Media
• Chapter 6: The Culture of Healthcare
• Chapter 7: Ensuring Patient Safety
• Chapter 8: Leadership and Collaboration
• Chapter 9: Ethical and Legal Aspects of Professionalism
• Chapter 10: Teaching and Assessing Professionalism
• Chapter 11: Regulation of Healthcare Professionals
• Recommended Books, Articles and Websites
• Index
• End User License Agreement