Ethics and Professionalism

00:00 In this lecture, we're going to talk about the relationship between ethics and professionalism.

00:08 So, people have talked about professionalism in variety of ways.

00:13 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.

00:26 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.

00:39 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.

00:48 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.

00:57 And harkening back to the lecture on virtue theory, the patterns of doing will evolve into patterns of being.

01:06 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.

01:21 Another key aspect of thinking about professionalism in your training is that it's a process of socialization.

01:28 So, you're training with other people that also have that same goal of being there for patients.

01:34 So that socialization as a clinician that leads to your identity formation is an ongoing process.

01:41 And it doesn't just end in medical school, in nursing school or resident for physicians, it's throughout your career.

01:48 That it's an ongoing process of socializing with your peers, with other disciplines, with other professionals and serving the interest of patients.

01:59 Now the profession, you know the group of people that, you know, say that they are professionals developed codes, 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.

02:17 So those codes sort of give us some guide post, but again you have to apply that to each individual patient situation.

02:28 And organizations, you know, professional organizations are going to articulate hopefully the core values that are important for being a professional.

02:38 So what are the hallmarks of a profession? Well, first of all you have to have expertise.

02:42 So, all the training, all the learning that you do to hone your craft creates some expertise that is differentiated from being an amateur.

02:55 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.

03:04 And it's going to be important for the hallmark of a profession that it is in service to matters of social importance.

03:10 So we view health as very important as human beings.

03:14 We view illness as something that we want to try to prevent or, you know, take care of when it does exist.

03:22 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.

03:31 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.

03:44 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.

04:20 You have to decide for yourself how you're going to apply those general guidelines to your own profession.

04:29 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.

05:01 Like what I talked about in the previous lecture has produced shared responsibility.

05:06 So you are going to serve their best interest and they have to trust that.

05:10 When you make recommendations, that is really for their benefit.

05:16 As I mentioned, there has to be some degree of accountability and self-regulation within the community.

05:21 Now this has some controversy to it.

05:25 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.

05:47 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.

06:03 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.

06:16 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.

06:35 So first of all, the primacy of patient welfare.

06:38 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.

06:51 It also said that another key value of the profession is social justice.

06:56 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.

07:11 So, social justice has another key value.

07:14 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.

07:25 And we try to meld all 3 of these together when we're thinking about being a professional.

07:31 And there are going to be various ways that this can actually manifest themselves in how we do our work.

07:36 What are the things that we have to adhere to to serve those 3 values? The first would be professional competence.

07:43 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.

07:53 So you have to be confident in your work.

07:55 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.

08:12 It also means that we're going to have honesty with patients.

08:15 So, another core value we talked about in terms of virtue theory, being truthful with patients.

08:22 It may be that it's going to be paying attention to confidentiality.

08:27 We'll have a future lecture about confidentiality 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.

08:45 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.

08:56 Other commitments that we have to pay attention to in terms of professionalism are improving the quality of care.

09:02 So always striving for improvement.

09:06 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.

09:22 Speaking to social justice, it also means improving access to care.

09:26 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.

09:50 When we're thinking about resources, you know, there are finite resources.

09:54 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.

10:13 Another thing that's important in terms of professional competence is scientific knowledge.

10:18 So that's, you know, your own knowledge base but it also means that commitment to advancing science.

10:24 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.

10:42 Lastly, another professional commitment for all of us should be maintaining trust.

10:47 So that means managing conflicts of interest as you enter into profession.

10:52 There may be your own personal interest you need to pay attention to.

10:56 There may be other obligations that you have to fulfil, not just your professional obligation.

11:01 So, how do you balance those personal interests, those other obligations that you have as, you know, a person, as an individual.

11:10 Compare that to your professional obligations, how do you still be there for your patients.

11:17 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.