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Professionalism in Medicine: An A-Z Primer
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Patrick Duff, MD,a
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To be successful as physicians, we should adhere to a simple,
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time-honored code of conduct. We must commit ourselves to a lifetime of
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self-directed learning. We must strive to be thoughtful, kind, and
sensitive. We must avoid arrogance, dogmatism, and negativism. We must
be honest, moral, tolerant, trustworthy, and above all else, humble and
compassionate. Consistent adherence to these traits will help us
maintain the nobility and credibility of the medical profession.
aUniversity of Florida, College of Medicine, Department of Obstetrics
and Gynecology, Division of Maternal-Fetal Medicine, Gainesville,
Florida, USA
(Obstet Gynecol 2002:99:1127-1128. © 2002 by The American College of
Obstetricians and Gynecologists.)
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I have practiced medicine for 27 years, first as a resident and fellow,
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then as a student clerkship director, division chief, residency
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director, and finally an associate dean of students. In my experience,
I have observed that very few physicians falter because of a lack of
intellect or a major deficit in technical skills. Rather, the few that
are not successful in their practice have difficulty because of poor
professional behavior. Medicine demands an exceptionally high standard
of professionalism, and this high standard can be achieved by virtually
all of us if we simply remember that, to be good physicians, we first
must be good people. I offer the following A-Z primer as a reminder of
the simple rules of good behavior in medical practice.
A is for arrogance. We must avoid it at all costs. There is no other
trait that puts others off as much as arrogance. It severely tarnishes
the brightest intellect and the most superb technical skills. For all
of our formal education and rigorous training, we are no better or worse
than anyone else engaged in an honest endeavor.
B is for benevolence. We must treat everyone with kindness and not let
anger and malice have any role in our professional interactions.
C is for compassion. We must strive to display it in full measure when
interacting with patients. Compassion is particularly important in
situations when cure of disease is impossible and when we struggle
simply to sustain the human spirit and provide comfort for an ailing
body.
D is for dogma. We should eschew it and practice on the basis of the
best available medical evidence, not in accordance with strongly voiced
opinions or comfortable old habits.
E is for an even temperament. We must work hard to cultivate one. Our
responses to different situations should be predictable and consistent.
Our patients, students, and colleagues should not have to walk on
eggshells because we are in a bad frame of mind.
F is for fair minded. We must be consistently equitable in our
interactions with others. We always must strive to put the interest of
our patient first and to do what is right and just, not what is
expedient or financially profitable.
G is for good humor. We must try to display one consistently. We must
not take ourselves too seriously, and we must be willing to laugh at our
foibles and avoid a pattern of defensiveness.
H is for honesty and humility. These may, in fact, be the most
important of all personal traits. The former is the rock upon which we
build our professional reputation; the latter enhances our achievements
with the soft light of graciousness.
I is for insight. We must recognize not only our strengths, but also
our limitations. We must not let ego interfere with good patient care.
No matter what our level of training or breadth of experience, we never
should hesitate to ask for assistance when confronted by unfamiliar
situations.
J is for judgment. We must avoid the rush to it—in making a diagnosis
or adopting a new therapy. We must acknowledge that most serious
mistakes in medicine result more from haste than lack of expertise.
Therefore, we must strive to be calm, logical, and deliberate in our
approach to patient care.
K is for knowledge. We must stay informed of the facts by making a
lifetime commitment to self-education. We must remain abreast of the
scientific literature, read avidly and critically, and be conservative
in evaluating apparent startling new developments. We should neither be
the first to adopt the new nor the last to abandon the old.
L is for listen. We learn the most by listening to our colleagues and
our patients, not by talking. Sometimes the best medicine is no
medicine at all, but rather a soft shoulder, a kind heart, and a
receptive ear.
M is for modesty, a trait that complements humility. Our counseling of
patients, students, residents, and coworkers is far more likely to be
heeded if we are well regarded by others rather than being perceived as
demanding, abrasive, and insensitive.
N is for negativism. We must avoid it at all costs. We must remain
free of the company of angry, negative people, for they will be like
anchors that weigh us down. We must strive to be part of the solution
to a problem, not part of the problem itself.
O is for open mindedness. We must be tolerant of others. Many patients
will have lifestyles that are quite different from our own. In fact,
many of their illnesses may be the direct result of their unhealthy
patterns of behavior. Nevertheless, they are deserving of our respect,
sympathy, and expertise.
P is for promptness. We must be respectful of other individuals' time,
particularly our patients. We should not overschedule ourselves so that
we are unable to accord patients the time they deserve for assessment of
their medical problem.
Q is for quizzical. We continually must ask new questions to expand our
fund of knowledge and enhance our efficiency. We must be willing to
think outside the box in creating new ways to deliver compassionate,
expert, and cost-efficient care to patients.
R is for reliable. We must be steady and dependable. Colleagues and
patients should feel secure in depending on us to complete assignments
and honor deadlines. We must learn to say "no" politely but firmly when
our plate is too full. When we promise to do something, we need to do
it right and on time. R is also for respect. We must earn it, from
both our colleagues and our patients by our conscientious, dutiful
actions.
S is for sensitivity. We must display this trait in full measure in our
interactions with patients and colleagues.
T is for tact. We must be able to give constructive criticism to
students and colleagues without crushing their self-esteem. Similarly,
we must be able to provide realistic assessments to patients without
taking away their hope or belittling their judgment.
U is for user friendly. We must be willing to change outdated methods
of doing business and make traditional practices (eg, admission to the
hospital, scheduling of appointments, hospital room assignments,
laboratory tests) convenient, dignified, and culturally sensitive for
our patients.
V is for vigor. We must avoid the phenomenon of burn-out and remain
passionate and positive in our approach to our personal and professional
lives.
W is for work ethic. Ours must be impeccable. We must strive for the
endurance and consistency of the long-distance runner over the flash of
the sprinter. Slow and steady wins the race to excellence in patient
care. W is also for well organized. Good organization is the key to
efficiency and productivity in any profession, but particularly medicine
where the demands on our time are intense and so often unpredictable.
X is for eXacting standards. We should set the bar of performance at a
lofty height, but not impossibly high. We should strive consistently
for excellence but not perfection. A standard of perfection will always
be unrealistic and elusive and invariably will lead to disappointment
and loss of self-esteem.
Y is for yourself. We must be ever attentive to the proper balance
between our professional and personal lives. We must nourish our mind,
spirit, and body so that we are able to care properly for our loved ones
and our patients.
Z is for zero tolerance. This is the type of personal and corporate
policy that we should have toward sexism, boorishness, and ethnic,
racial, age, or gender discrimination.
I conclude with several simple suggestions for how professionalism might
be taught during medical school and residency training. First, faculty
members must model desirable professional behaviors so that students and
residents have excellent examples to emulate. Second, professional
behavior can be taught in the context of small group seminars where
students are presented with difficult scenarios (eg, the noncompliant
and hostile patient, suspected drug abuse by a colleague, suspected
financial improprieties by a partner, need for correction of
inappropriate behavior by a student or resident during rounds). Third,
students and residents may be assigned readings on the subject of
professionalism and be required to attend lectures or seminars that
discuss ethical and professional behavior. Residents and students
should be evaluated by patients, ancillary staff, and faculty concerning
their behavior. Finally, as is now mandated by the Accreditation
Council on Graduate Medical Education and the Residency Review Committee
for Obstetrics and Gynecology, professional behavior should be brought
to the forefront of the curriculum and made one of the major criteria
for student or resident promotion and graduation.
Reprints are not available. Address correspondence to: Patrick Duff,
MD, University of Florida, College of Medicine, Department of Obstetrics
and Gynecology, Division of Maternal-Fetal Medicine, P.O. Box 100294,
Gainesville, Florida 32610-0294; E-mail: duffp@obgyn.ufl.edu
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Copyright © 2002 by The American College of Obstetricians and
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Gynecologists
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Published by Elsevier Science Inc.
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--
"Life is neither the notes nor the silence between the notes, but the music that
arises out of sound and silence felt as a living whole. Stop choosing...between
chaos and order, and live at the boundary between them, where rest and action
move together..." David Whyte
