The core of professionalism is embedded in the daily healingwork of the physician and encompassed in the patient-physicianrelationship. Professionalism includes an appreciation for the cultural and religious/spiritual health beliefs of the patient,incorporating the ethical and moral values of the profession andthe moral values of the patient. Unfortunately, the inappropriateactions of a few practicing physicians, physician investigators,and physicians in positions of power in the corporate world have created a societal demand to punish those involved andhave led to the erosion of respect for the medical profession.
The American Academy of Pediatrics (AAP), the American Board of Pediatrics (ABP), the American Board of Internal Medicine, the LCME, the Medical School Objectives Project of the Association of American Medical Colleges, and the ACGME Outcome Project have called for increasing attention to professionalism in the practice of medicine and in the education of physicians.
The ABP adopted professional standards in 2000, and the AAP updated the policy statement and technical report on Professionalism in 2007, as follows:
Honesty/integrity is the consistent regard for the highest standards of behavior and the refusal to violate one’s personal and professional codes. Maintaining integrity requires awareness of situations that may result in conflict of interest or that may result in personal gain at the expense of the best interest of the patient.
Reliability/responsibility includes accountability to one’s patients and their families, to society to ensure that the public’s needs are addressed, and to the profession to ensure that the ethical precepts of practice are upheld. Inherent in this responsibility is reliability in completing assigned duties or fulfilling commitments. There also must be a willingness to accept responsibility for errors.
for others is the essence of humanism. The pediatrician must treat all persons with respect and regard for their individual worth and dignity; be aware of emotional, personal, family, and cultural influences on a patient’s well being, rights, and choices of medical care; and respect appropriate patient confidentiality.
Compassion/empathy is a crucial component of medical practice. The pediatrician must listen attentively, respond humanely to the concerns of patients and family members, and provide appropriate empathy for and relief of pain, discomfort, and anxiety as part of daily practice.
Self-improvement is the pursuit of and commitment to providing the highest quality of health care through lifelong learning and education. The pediatrician must seek to learn from errors and aspire to excellence through self-evaluation and acceptance of the critiques of others.
Self-awareness/knowledge of limits includes recognition of the need for guidance and supervision when faced with new or complex responsibilities. The pediatrician also must be insightful regarding the impact of his or her behavior on others and cognizant of appropriate professional boundaries.
Communication/collaboration is crucial to providing the best care for patients. Pediatricians must work cooperatively and communicate effectively with patients and their families and with all health care providers involved in the care of their patients.
Altruism/advocacy refers to unselfish regard for and devotion to the welfare of others. It is a key element of professionalism. Self-interest or the interests of other parties should not interfere with the care of one’s patients and their families.
The ethics of health care and medical decision making relies on values to determine what kinds of decisions are best or appropriate for all. Sometimes ethical decision making in medical care is a matter of choosing the least harmful option among many adverse alternatives. In the day-to-day practice of medicine, although all clinical encounters may have an ethical component, major ethical challenges are infrequent.
The legal system defines the minimal standards of behavior required of physicians and the rest of society through the legislative, regulatory, and judicial systems. Laws exist to provide for social order and adjudicate disputes, not to address ethical concerns. The laws support the principle of confidentiality for teenagers who are competent to decide about such issues. Using the concept of limited confidentiality, parents, teenagers, and the pediatrician may all agree to openly discuss serious health challenges, such as suicidal ideation and pregnancy. This reinforces the long-term goal of supporting the autonomy and identity of the teenager while encouraging appropriate conversations with parents.