As a collective whole, doctors are regarded as “professionals” both by the public and by their peers. They remain the most trusted profession among the public, which has been the case for many years. Individually, some doctors may fall short of the mark. But what do we mean by professionalism? And how much bearing does this definition have on the behaviours expected of a doctor? Firstly, we need to be clear about exactly what a profession is.
"A professional is someone who can do his best work when he doesn’t feel like it" -
Alistair Cooke, American journalist (1908-2004)
How do you define a profession?
A profession can be defined as a vocation or ‘calling’, especially one involving a degree of skill, learning or science. Another helpful description is that of “a trade or occupation pursued for higher motives, to a proper standard”.
The distinction is usually drawn between a professional (ie, someone who earns a living from their trade or occupation), and an amateur (ie, someone who might do the same or a similar thing, but without remuneration). But the difference is not simply that one is paid and the other is not, because a ‘professional’ performance is one which is good, polished and of a high quality, whereas an ‘amateurish’ performance is the opposite – however much or little payment might have been received.
A logical conclusion is that if a person intends to rely upon a certain trade or occupation as their main source of income, then they would need to be proficient at it, and be recognised as being so.
How does this apply to medicine?
"All professions are a conspiracy against the laity" -
George Bernard Shaw, The Doctor’s Dilemma (1911)
Bernard Shaw’s cynicism may well be anachronistic given the patient-centred and shared decision-making approach favoured in medicine today. Modern medical professionalism includes the ability to communicate specialist knowledge, diagnosis and treatment options in an easy-to-understand way, rather than seeking to use specialist knowledge as a means to create distance from, and a dependency of, the public. Professionalism also involves confidentiality, continuity, trust, honesty and compassion.
Older definitions of professionalism pitched the doctor in an exclusive group, defined through specialist knowledge and expertise. Today, information about health and disease is available to anyone with access to a computer, and the definition of professionalism in healthcare has had to adapt and change in an increasingly consumerist healthcare sphere.
Dame Janet Smith stated that: “Professionalism is a basket of qualities that enables us to trust our advisors.”2 A patient’s trust in a doctor is no longer assumed; it is reached through a display of appropriate professional qualities: expertise, probity, integrity, and so on.
In 2005, the Royal College of Physicians (RCP) produced a report, Doctors in Society: Medical Professionalism in a Changing World, to seek to redefine the nature and role of medical professionalism in a modern society. The report agreed that professionalism in healthcare can be defined as:
“A set of values, behaviours, and relationships that underpins the trust the public has in doctors.”
Furthermore, the RCP working group concluded that in their day-to-day practice, doctors are committed to:
working in partnership with members of the wider healthcare team.3
Following on from the older definitions of “lofty professionalism”, as discussed above, is the assumption that professional qualities are automatically inherited upon qualifying. As medicine is a profession, such thinking follows that all doctors are automatically professionals. However, this booklet serves to show this is not the case. Modern medical professionalism is something that can, and indeed should, be learnt. Being aware of the expectations of a professional can help to improve patient care. It is important to continually develop communication skills, clinical knowledge and team-working skills in order to help improve standards.
Other professional standards
In other professions, too, similar qualities of trust, responsibility and integrity apply. The Solicitor Regulation Authority’s Code of Conduct states that: “Those involved in providing legal advice and representation have long held the role of trusted adviser.” The mandatory principles that apply to all legal professionals include: acting with integrity; not allowing independence to be compromised; acting in the best interests of each client; and behaving in a way that maintains the trust the public places in the individual solicitor and in the provision of legal services.4 The Teaching Agency is responsible for the regulation of professional conduct; if standards of an individual teacher fall below the expected levels, sanctions are imposed and, in serious instances of professional misconduct, they may be barred from teaching. The onus on standards and regulation is not solely on the medical profession.
Does professionalism equal perfectionism?
There is a flip side to the pressures of striving to be professional in the medical profession. Perfectionism is a common trait amongst doctors. People who are perfectionists strive for flawlessness, set excessively high standards of performance, and tend to be overly critical of their behaviour.5 Far from bringing the profession into disrepute, many doctors strive for extremely high standards, and can be at risk of burnout in their quest to ensure high-quality healthcare and safeguard patient safety.
It is important to remember that doctors are human too; mistakes will be made, and sometimes doctors will fall short of the high ideals that the public, and they themselves, expect. Adverse outcomes can result from care in the most experienced hands – it is not necessarily a sign of poor care or lack of commitment. True professionalism comes into play when mistakes are made. Knowing what to do when things go wrong and how to react appropriately can make all the difference in ensuring high standards of patient care are maintained and a speedy resolution is reached. More can be found on what to do when things go wrong in Chapter 4.