In this lecture, we're going to talk about the
relationship between ethics and professionalism.
So, people have talked about
professionalism in variety of ways.
And I think it's important especially
for medical students, nursing students
to recognize that your identity as a professional
has to meld with your own personal identity.
And so when you're in your medical
education or nursing education,
your health professional education, you have to pay
attention to that professional identity formation.
And the ultimate goal of that is that
at the end of that, all that training,
you're going to think, act
and feel like a clinician.
You're still going to be your own self,
but you're now going to have this
additional identity of being the
clinician that's there for the patient.
And harkening back to the
lecture on virtue theory,
the patterns of doing will
evolve into patterns of being.
So, those habits of character, the more
you perform actions as a professional,
you know, developing professional,
the more you do that then
it just becomes part of who you are becomes
part of your essence or your being.
Another key aspect of thinking about professionalism in
your training is that it's a process of socialization.
So, you're training with other people that also
have that same goal of being there for patients.
So that socialization as a clinician that leads
to your identity formation is an ongoing process.
And it doesn't just end in medical school, in nursing school
or resident for physicians, it's throughout your career.
That it's an ongoing process of
socializing with your peers,
with other disciplines, with other professionals
and serving the interest of patients.
Now the profession, you know the
group of people that, you know,
say that they are professionals
you know standards of conduct
that are going to be guidance
in how you should behave as that professional
whether it's a physician or nurse or so on.
So those codes sort of
give us some guide post,
but again you have to apply that to
each individual patient situation.
And organizations, you know, professional
organizations are going to articulate
hopefully the core values that are
important for being a professional.
So what are the hallmarks
of a profession?
Well, first of all you
have to have expertise.
So, all the training, all the learning
that you do to hone your craft
creates some expertise that is
differentiated from being an amateur.
So we have a store of knowledge
that is different from the patient
from a lay person that doesn't
have that background in training.
And it's going to be important
for the hallmark of a profession
that it is in service to
matters of social importance.
So we view health as very
important as human beings.
We view illness as something that
we want to try to prevent or,
you know, take care of
when it does exist.
And so that's socially important and the
hallmark of a profession is going to be
you're trying to serve that thing
that is socially important.
It also means that you said in some way
that you are committed to this idea
that for physicians they might talk about the Hippocratic
Oath, you know at the end of medical school.
Their nursing codes, ethics that in some
way you profess, you say positively
"Yes, I'm going to abide by the norms of the
profession in the interest of patients."
And it also means that once you're in the
profession, you have a certain degree of autonomy
and so what that means is, you know, why you are
adhering to certain norms or codes or rules,
guidelines from a profession that you do have
some autonomy in how you conduct your work.
You have to decide for yourself how you're going to
apply those general guidelines to your own profession.
And, you know, the hallmark of
profession is also going to be
that there are these norms of conduct and
when there are concerns about you not
adhering to those norms that there are
some means of accountability that,
you know, as a profession, as a
group you're going to say, you know
"Is this remissible or impermissible?" In the
end, what you're trying to do as a group
as the profession is adhered to
this idea of trust that the patient
that's coming to you trust if you are
going to serve their best interest.
Like what I talked about in the previous
lecture has produced shared responsibility.
So you are going to serve their best
interest and they have to trust that.
When you make recommendations,
that is really for their benefit.
As I mentioned, there has to be some degree of
accountability and self-regulation within the community.
Now this has some
controversy to it.
You know, some people would argue that the
profession is a guild that has self-interest
and that they are just looking out for themselves
and maybe not really thinking about the patient,
you know, society as a whole and serving, you
know, the things that are socially important
that they're really trying to protect
just the profession and its interest.
I think that's something that's
worth debating and discussing
because the profession is ever evolving
and we need new voices to sort of talk to
how do we both self-regulate but also
pay attention to those core values.
And what are those core values? So, one
place to start and this was back in 2002,
a group of professional societies got together
and they created a charter on professionalism.
They were recognizing that we are entering
into a new millennium and needed to say
"Okay, what are the things that are really important for
us as a profession to make sure that we adhere to?"
And they said that there were 3
key values and these are things
that you've heard we talked about in
other lectures about medical ethics.
So first of all, the primacy
of patient welfare.
So, we are there for the patient, for their
well-being to help them with their illness,
with their disease to keep them healthy.
Their welfare is primary.
It also said that another key value
of the profession is social justice.
So this was written at a time where we
were starting to get a greater recognition
that things that were, you
know, socially important
we need to pay attention to justice
issues and making sure that
how the systems are set
up are fair to everyone.
So, social justice has
another key value.
And lastly, you know, because we're in the idea of
patients should be able to make their own decisions,
this idea of patient
autonomy, another key value.
And we try to meld all 3 of these together when
we're thinking about being a professional.
And there are going to be various ways that this can
actually manifest themselves in how we do our work.
What are the things that we have to
adhere to to serve those 3 values?
The first would be
So, the reason you do all the
training, you get all the knowledge
is that you are going to be able to handle the
problems that you face with each individual patient.
So you have to be
confident in your work.
And the other thing I mentioned in previous lectures is
you also have to have a commitment to ongoing learning
that if you don't know something
you're going to read about it,
learn about it, try to figure
it out to help your patient.
It also means that we're going
to have honesty with patients.
So, another core value we talked about in terms
of virtue theory, being truthful with patients.
It may be that it's going to be
paying attention to confidentiality.
We'll have a future lecture
and making sure the private
information that the patient give us
that we are protecting that especially in
an era where we have the information age
and access to lots of information about people that we're
going to maintain confidentiality with our patients.
It also means maintaining appropriate
relationships with our patients
and not taking advantage of the vulnerability
that they have as a result of their illness.
Other commitments that we have to pay attention to in terms
of professionalism are improving the quality of care.
So always striving
So, we, you know, assessing what we've done before.
Did it work? How can we improve the quality?
And always having this idea
of trying to do better,
trying to make the healthcare system as a whole
better and our individual practice better.
Speaking to social justice, it also
means improving access to care.
So, making sure that people
can get the care they need
and that we don't put up barriers for
them getting appropriate healthcare
and that it's affordable for them, you
know, they're different countries
where this may be more or less medically available but
making sure that there is good access to care for everybody.
When we're thinking about resources,
you know, there are finite resources.
There is only so much money
that can be used for healthcare
so we have to make sure that it
is distributed justly and fairly,
and not favoring one segment
of society or another,
but that everyone gets access to it and
gets the benefit of using those resources.
Another thing that's important in terms of
professional competence is scientific knowledge.
So that's, you know, your own knowledge base but it
also means that commitment to advancing science.
So whether it means participating
in research or encouraging research
so that you can get new technology,
you can get new innovation,
you can figure out how to cure diseases
and emphasis on really making sure
that science advances as well
as taking care of patients.
Lastly, another professional commitment for
all of us should be maintaining trust.
So that means managing conflicts of
interest as you enter into profession.
There may be your own personal
interest you need to pay attention to.
There may be other obligations that you have to
fulfil, not just your professional obligation.
So, how do you balance those personal
interests, those other obligations
that you have as, you know,
a person, as an individual.
Compare that to your professional obligations,
how do you still be there for your patients.
So the hope is that when you take this
charter on professionalism, you know,
20 years old now but thinking about that
and applying that to your own work,
you know to your own career, think about
how you would apply these values,
how you are going to be the
commission you want to be.