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Professionalism
Definition: Professionalism
is the basis of medicine's contract with society. It demands placing the
interests of patients above those of the physician, setting and maintaining
standards of competence and integrity, and providing expert advice to
society on matters of health.
Fundamental Principles
- Principle of primacy of patient welfare
This principle is based on a dedication to serving the interest of the
patient. Market forces, societal pressures, and administrative exigencies
must not compromise this principle.
- Principle of patient autonomy
Physicians must have respect for patient autonomy. Patients' decisions
about their care must be paramount, as long as those decisions are in
keeping with ethical practice and do not lead to demands for inappropriate
care.
- Principle of social justice
The medical profession must promote justice in the health care system,
including the fair distribution of health care resources. Physicians
should work actively to eliminate discrimination in health care, whether
based on race, gender, socioeconomic status, ethnicity, religion, or
any other social category.
A Set of Professional Responsibilities
- Commitment to professional competence
Physicians must be committed to lifelong learning and be responsible
for maintaining the medical knowledge and clinical and team skills necessary
for the provision of quality care.
- Commitment to honesty with patients
Physicians must ensure that patients are completely and honestly informed
before the patient has consented to treatment and after treatment has
occurred. Physicians should also acknowledge that in health care, medical
errors that injure patients do sometimes occur. Whenever patients are
injured as a consequence of medical care, patients should be informed
promptly because failure to do so seriously compromises patient and
societal trust. Reporting and analyzing medical mistakes provide the
basis for appropriate prevention and improvement strategies and for
appropriate compensation to injured parties.
- Commitment to patient confidentiality
Earning the trust and confidence of patients requires that appropriate
confidentiality safeguards be applied to disclosure of patient information.
- Commitment to maintaining appropriate relations with patients
Given the inherent vulnerability and dependency of patients, certain
relationships between physicians and patients must be avoided. In particular,
physicians should never exploit patients for any sexual advantage, personal
financial gain, or other private purpose.
- Commitment to improving quality of care
Physicians must be dedicated to continuous improvement in the quality
of health care.
- Commitment to improving access to care
Medical professionalism demands that the objective of all health care
systems be the availability of a uniform and adequate standard of care.
A commitment to equity entails the promotion of public health and preventive
medicine, as well as public advocacy on the part of each physician,
without concern for the self-interest of the physician or the profession.
- Commitment to a just distribution of finite resources
While meeting the needs of individual patients, physicians are required
to provide health care that is based on the wise and cost-effective
management of limited clinical resources.
- Commitment to scientific knowledge
Much of medicine's contract with society is based on the integrity and
appropriate use of scientific knowledge and technology. Physicians have
a duty to uphold scientific standards, to promote research, and to create
new knowledge and ensure its appropriate use.
- Commitment to maintaining trust by managing conflicts of interest
Medical professionals and their organizations have many opportunities
to compromise their professional responsibilities by pursuing private
gain or personal advantage. Such compromises are especially threatening
in the pursuit of personal or organizational interactions with for-profit
industries, including medical equipment manufacturers, insurance companies,
and pharmaceutical firms.
- Commitment to professional responsibilities
As members of a profession, physicians are expected to work collaboratively
to maximize patient care, be respectful of one another, and participate
in the processes of self-regulation, including remediation and discipline
of members who have failed to meet professional standards.
Medical Professionalism: A Physician Charter (Abstracted
from Annals of Intern Medicine 2002;136:243-246).
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