Part 1 – The characteristics of a professional
In Chapter 1, we tried to define professionalism; in particular, how it relates to the concept of a “profession”. Here we look at some of the characteristics commonly associated with a professional person; as a doctor, these are perhaps the minimum expectations patients have of you. Ultimately these characteristics together create the foundation stone of the doctor–patient relationship: trust.
Expertise
A professional person is expected to have a particular set of skills in their chosen field, at a level that can be considered expert. This will have been acquired through learning, knowledge, training and practice of the relevant skills and, in most cases, this can be demonstrated by qualifications or accreditation of some kind. The validity of this expertise is maintained by ongoing training throughout the course of a medical career.
"A professional person is expected to have a particular set of skills in their chosen field, at a level that can be considered expert"
Standards
A professional person is expected to have the ability and dedication to achieving a set of standards in their duties that their peers find acceptable.
Respectability
There are expectations that a professional will work and behave in a manner that is appropriate to the nature of their particular profession. In medicine, these expectations are unique: good standards of personal appearance and dress, appropriate standards of speech and personal conduct – such attributes will confirm to a patient an acceptable standard of respectability.
Doing what is right – when the law requires it, as well as for ethical or moral reasons – should be a matter of personal pride for the professional person
Responsibility and reliability
Honouring commitments and keeping promises are key aspects of a professional person’s sense of responsibility and reliability. Ensuring that tasks and duties are completed and addressed, by taking the initiative and leading by example, are imperative in medicine, where a lack of immediate attention to your duties can be the difference between life and death.
Doing what is right – when the law requires it, as well as for ethical or moral reasons – should be a matter of personal pride for the professional person
Probity
The word “probity” is taken from the Latin for good, honest and upright. A professional person should be all these things, as well as fair, law-abiding and of general good character. Probity is central to the public trust placed in the medical profession and a professional person should, through their actions, uphold this reputation. We will look in more detail at the GMC’s expectations around probity later in this chapter.
Conduct
The actions of a professional person will be seen by both the public and their fellow professionals as being appropriate and proper. Again, the GMC has clear expectations of the correct behaviour and conduct of a medical professional, and this will be explored later in this chapter.
Respect
Respect for authority and the rule of law are traits of a professional person, and this respect should be maintained when managing or employing others. A professional person should aim to be courteous and should at the very least respect the rights, dignity and autonomy of others.
Professional vs unprofessional
A professional person will:
- Take pride in doing a job well and pay attention to detail
- Take personal responsibility for their actions and the consequences
- Seek to develop and improve their skills
- Not be satisfied with a substandard result, and will seek to put things right
- Be prepared to acknowledge mistakes, learn from them and take appropriate steps to prevent recurrence
- Show respect for those who consult them in a professional capacity.
In medicine, some examples of unprofessional behaviour may include:
- Any criminal behaviour or conviction
- Behaviour that suggests a disregard for the wellbeing of patients, or members of the public, and/or their dignity and rights
- Failing to honour clinical commitments
- Rude, abusive or disrespectful behaviour
- An irresponsible or apathetic attitude
- Showing a disregard for the time and effort of those who are relying on them – for example, by consistently bad timekeeping
- Dishonest business/financial dealings
- Any abuse of the doctor–patient relationship
- Anything that undermines public confidence in the profession
- Anything that undermines the reputation or standing of the profession
- Selfishness: putting one’s own financial or personal interests above all other considerations
- Accepting unsatisfactory clinical standards
- Gratuitous criticism of colleagues and others
- Inappropriate relationship with patients, employees, etc
- Treating patients when not fit to do so
- Agreeing to undertake a procedure for which the person lacks the necessary training, expertise or competence
- Being resistant to feedback or maintaining one’s continuing professional development
- Laziness, sloppiness or a lack of attention to detail.
Social responsibility
Many of the characteristics listed at the beginning of this chapter relate to those directly linked to a person’s professional role, and are generally concerned with the individual’s ability to carry out their duties. But in medicine, this is not enough; the caring nature of the profession means that a healthcare professional must possess a strong sense of empathy, a desire to do good – and this can be broadly described as having a social responsibility.
Professional integrity is a precious attribute that needs to be cultivated and protected from the very start of a professional career, including entry to medical school
This might include:
- Compassion for those suffering pain and hardship
- A proper and responsible role in society
- A responsible attitude to the environment (especially in relation to the management of clinical and hazardous waste, the use of energy and raw materials)
- Good employment practices (in the case of self-employed GPs or doctors working in private practice)
- An awareness of social issues where the medical profession is in a position to play an important or central role (eg, physical abuse in all its forms, discrimination, etc)
- Humanity in both professional and personal matters (eg, proving assistance in an emergency situation, a Good Samaritan act)
- Adherence to the law (eg, in relation to substance abuse, driving while unfit to do so).
Summary
Doing what is right – when the law requires it, as well as for ethical or moral reasons – should be a matter of personal pride for the professional person.
Persisting in doing what is right, on those occasions when it is much easier, quicker and cheaper or more convenient to do otherwise, is a greater test.
Some will no doubt maintain that the ethos of professionalism, and the instinct that tells us what a professional person would do in a given situation, can only develop with experience. Others will argue that professionalism is simply about making the right choices, for the right reasons, no matter what stage in your professional career these decisions arise. There may be some truth in both perspectives, but it can never be too soon to think these issues through. Professional integrity is a precious attribute that needs to be cultivated and protected from the very start of a professional career, including entry to medical school.
Part 2 – The GMC expects
The GMC’s role in safeguarding professionalism in medicine stems from its founding in 1858, when it was set up to expunge so-called “quacks” from practising and to ensure uniformity of qualifications. The GMC harvested representative selfgovernance and took on a disciplinary function for any medical professional guilty of “infamous conduct in a professional respect” – a term first defined in the 1894 case of Allinson v General Medical Council.
In that case, Lord Justice Lopes said: “If a medical man in the pursuit of his profession has done something with regard to it which will be reasonably regarded as disgraceful or dishonourable by his professional brethren of good repute and competency, then it is open to the General Medical Council, if that be shown, to say that he has been guilty of infamous conduct in a professional respect.”6
Today, the GMC looks for evidence of impaired fitness-to-practise before it can take action to stop or limit a doctor’s right to practise
The phrase was then enshrined in law in the consolidated Medical Act of 1956:
“If any fully registered person –
(a) is convicted by any court in the United Kingdom or the Republic of Ireland of any felony, misdemeanour, crime or offence, or
(b) after due inquiry is judged by the Disciplinary Committee to have been guilty of infamous conduct in any professional respect, the Committee may if they think fit direct his name to be erased from the register.”7
Today, the GMC looks for evidence of impaired fitness-to-practise before it can take action to stop or limit a doctor’s right to practise. According to the GMC website, this evidence may be that doctors:
- “have not kept their medical knowledge and skills up to date and are not competent;
- have taken advantage of their role as a doctor or have done something wrong;
- are too ill, or have not adequately managed a health problem, to work safely.”8
Such evidence leads the GMC to direct the Medical Practitioners Tribunal Service to hold a fitness-to-practise hearing. Alternatively, any significant departure from the principles of the GMC guidance Good Medical Practice may also lead to a fitness-to-practise hearing. Originally published in 2006 and revised in 2013, Good Medical Practice set out the most comprehensive set of standards of conduct and care ever compiled in the UK. This core guidance sets out the standards by which doctors are judged and, therefore, can be viewed as the tenets of what it is to uphold professionalism in the healthcare industry.
The following articles will look at some common categories of allegation heard at fitness-to-practice hearings. We will explore the GMC's expectations around each one and how they relate to the concept of being a good professional.