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Professionalism in Medicine

Jill Thistlethwaite and John Spencer have authored a thoughtful, well documented book that will satisfy everyone interested in what professionalism means and what it calls for in a doctor. The chapters that drew my rapt attention were the first, the second, the fifth, and the last. Not that the other eight chapters were less engaging or informative. Readers will find countless bits – some tantalizing in their brevity, others highly instructive in their details – on law and ethics, professional and patient relationships, autonomy, competence and cultural diversity, lifelong learning, self-care, and teaching and assessing professionalism. By the end of the book, readers will have a comprehensive view of what is needed in a professional: a compelling ensemble of attributes and behaviors that surely requires a lifetime of practice. Setting the basis of what is meant by professionalism, the opening chapter presents medical professionalism as the foundation of medicine’s contract with society. In exchange for the principled application of knowledge and skills in the best interest of patients, doctors gain autonomy, freedom to self-regulate, and considerable social status. Understandably, there are all the ingredients for both reverence and contempt, but also for periods of intense scrutiny of what may pass as monopoly and elitism. Examining the developments in both the UK and North America, the authors go on to explain what helped catalyzed thinking in medical professionalism, particularly in the last ten years or so. I savored reading the second chapter as it took me through the history of the concept starting with Hippocrates. What better way to learn about professionalism than in understanding its origins and evolution. Box 2.2 on p. 25 for example, presents a delightful view of important dates in the professionalization of medicine: from 1511 with the institution of license to practice to 1858 with the establishment of rights to the profession to selfregulate relatively freely from lay and government control – a highly questioned freedom in the new millennium, reported the authors in the preceding chapter, since both the profession and society must now clearly understand the elements of professionalism. The fifth chapter examines communication within teams and the value that interprofessional education may bring to clinical practice. Interestingly enough, clinical practice is the site for encounters with the expertise of multiple professionals, but also with uncertainty, ill defined problems, knowledge and ignorance, empathy and cynicism, cooperation and competition, altruism and selfishness, all human attributes in a highly humane endeavor: caring for the sick. Can the encounters of these attributes be regulated by the social contracts that define the professions? Can the elaboration of medical professionalism reduce or increase conflicts in interprofessional practice? Journal of Interprofessional Care, March 2010; 24(2): 213–216