Professionalism

The point of today, our second and final day of pure orientation activities, was to discuss the concept of “Professionalism.” Apparently this is a hot topic in medical education these days. For those of you not in the medical field, you might be wondering why professionalism is such an important point being emphasized in medical schools. After all, aren’t doctors supposed to be these amazingly smart and altruistic human beings putting their patients before just about anything? Furthermore, shouldn’t medical admission committees be picking students already exhibiting professionalism? Here’s an even better one you may be thinking…what the hell is professionalism?

These are all questions I had and still have. I hate discussing really abstract topics open to various lines of interpretation. To me, it’s akin to asking “what’s the meaning of life?” or something crazy and philosophical like that.

What’s kind of funny is I kind of get the feeling most current doctors feel the same way I do about professionalism. My dad’s a child and adolescent psychiatrist. I asked him today, what do you think professionalism in medicine means? After about a two second pause, “Umm, yeah, just be nice to your patients and don’t do anything stupid, you’ll be fine.”

Even my faculty interviewer, during my interview day at Case, brought up the point of professionalism. I think it was a standard question he was supposed to ask me. See, we were really talking about the Cavs for about 30 minutes, then he kind of forgot about the questions he was supposed to be asking me. So, here I am talking about LBJ’s lack of a jump shot and he just blurts out, “what does professionalism mean to you?” So I gave these awesome spiel about this book I read, Emotional Intelligence, and how success in life is predicated on interpersonal relationships and listening skills. I somehow tied that into my idea of professionalism, which is basically being a good person. I then flipped the question back at him. He was kind of stunned. He then looked me square in the eyes and said, “you need to show up on time.” Awesome. Don’t be late and you too will be exhibiting professionalism.

The point I’m trying to make is that professionalism is abstract and it means many different things to different people Communicate well (“be nice to your patients”). Be responsible (“show up on time”). Be competent (“don’t do anything stupid”). Etc.

And that was the goal today: to define what it means to be a professional. See, at Case we aren’t conventional. For one our curriculum is not typical. We have this weird Harry Potter social structure going on. Furthermore during our White Coat Ceremony we are not sworn in to our profession reciting the Hippocratic Oath. We make our own oath. And that, was what we were to do today.

It sounds pretty cool, and frankly it is a bit exciting. I understand why the school makes us go through this activity, See, professionalism, whatever that may mean, is a serious issue. We no longer live in a society where a physician is free to be the virtuous and wonderful healer that he or she is trained to be. Their lives are controlled by insurance companies, pharma and even the government. Health care costs are rising. People are getting fat and dying. Physicians are becoming ever more cynical of a modern medical system run by businessmen and bureaucrats. As such, they become cynical when the treat patients. They are angry at the system. They are angry at their patients for not taking proper preventive measures. They are angry at themselves for getting into medicine in the first place.

See at one point they were happy, little, idealistic medical students ready to go out there and change the world! Viva la revolucion, baby! Idealism is awesome, but it often is accompanied by unawareness.

I saw a bit of that idealism today. In order to create our class oath, we split up into small groups of about 11 students. The groups include our original IQ groups from yesterday with the addition of one or two students from the Cleveland Clinic Lerner College of Medicine (CCLCM). CCLCM trains students for careers as physician investigators. The program is research intensive and 5-years in length, but they still get their degrees from Case.

As a group we came up with a bunch of attributes a physician should exhibit. Some examples included, competence, compassion, empathy, humility among others. After spending an hour or so in our small group, we met in a larger group of about 40 students to create a condensed list.
It was when we were combining our lists I saw some of the idealism of some of my colleagues. What really struck me as the bulleted point on one of the lists stating “understanding the basic right to healthcare.” This statement kind of struck me because it didn’t seem necessarily appropriate to include it in a discussion of professionalism. An ideal physician has a responsibility to treat an individual patient regardless of his/her ability to pay. Nevertheless, this is not equivalent to saying that everyone has a right to healthcare. Maybe in Canada or the European Union sans Switzerland, but not here in America.

In fact, I’d be interested in knowing how many entering medical students think that a physician should believe that everyone deserves the right to basic healthcare. Personally, this is something I believe in, but I don’t think it is something that should constitute professionalism.

It seems as if the notion of a physician’s responsibility to an individual patient was being mixed with a physician’s responsibility to society. Notions of policy and public health arose during our discussion. Should a physician be an advocate for basic universal health care? Should a physician even have an obligation to society in the first place? Wow, these are some serious questions.

Seeing the idealism in the room was kind of exciting. While I‘ve had plenty of experiences with the health care system through my training as an EMT and my background in public health to have become completely jaded already, I felt a glimmer of hope again. Kind of like I did when I first decided to become a doctor. While talking about professionalism wasn’t necessarily my cup of tea, it was necessary. In our world today, it’s too easy to become cynical, no matter how kind-hearted you may be.

Here’s to hoping that glimmer of idealism doesn’t fade.