Caring for others requires deep human understanding and expertise on multiple levels (physical, psychological, emotional). The professional practice of medicine, when performed in a manner that is mutually beneficial to doctor, patient, and society, requires a set of sophisticated competencies in how to skillfully and compassionately understand and relate to the self and to others.
Professionalism, the term we apply to these skills, cannot be taught rapidly by lecture, but must be reinforced and nurtured throughout the clinical training of medical students and young house-staff, and throughout the career of the physician. Professional skills that are important for the benefit of the doctor include insight, emotional intelligence, communication skills, self-regulation, and high ethical standards.
Lack of professionalism in medical education
Medical student mistreatment has been a troubling reality in medical education. Documented as early as the 1980’s, it is rarely openly discussed as a causal factor in medical student or physician ill-being and acting out. In a longitudinal survey involving 16 nationally representative US medical schools, with an 80% response rate of 2316 students, 42% of seniors reported experiencing harassment and 84% reported experiences of belittlement during medical school.
Sources of this harassment and belittlement were residents (27%/71%), clinical professors (21%/63%) and other medical students (11%/32%). In addition, reports of physical and sexual abuse were not uncommon.
In a separate 2012 study of 4578 full-time academic faculty members at US medical schools, 21% were contemplating leaving academic medicine due to the non-relational culture and the low ethical values in their workplace. Based upon social learning theory of Bandura, people learn through observing others’ behavior, attitudes, and the outcome of those behaviors. In particular, behaviors exhibited by role models or people of admired status are more likely to have the greatest impact. Clearly, insight, emotional intelligence, communication skills, self-regulation, and high ethical standards are not being effectively taught or modeled in medical schools and teaching hospitals.
Professionalism in medical practice
A physician deals with stress, trauma, and difficult, complex ethical dilemmas on a daily basis. With the insight and emotional intelligence to be able to understand his own reactions to what is going on in his professional life, the self-regulation to know when and how to therapeutically vent his/her fears and frustrations away from patients, and the communication skills to be able to relate positively to patients and colleagues, the physician’s job becomes a welcome opportunity to serve others.
Professional skills that are beneficial for the patient include emotional intelligence, communication skills, listening skills, empathy, compassion, and high moral and ethical standards. First and foremost, patients need to be respected as the experts on their own bodies. Physicians, trained as medical students to always have the right answer on the spot, and pressed for time due to high volume demands, are never taught these key skills – skills that can make the difference between the correct or incorrect diagnosis, the ability to walk or loss thereof, and the like.
Professional skills that are beneficial to society include a respect and awareness of the patient as a social being belonging to a family, neighborhood, and larger group; the highest of ethical standards in eliminating prejudicial or excessive use of community resources; and persistent, patient teaching of positive health practices to patients, families and groups to prevent illness and encourage thriving.