By James Smith
As we navigate current and future health care transitions, I am skeptical that our conventional understanding of medical professionalism will assist us. We have defined and organized medical professionalism into list of codes, behaviors, and collective “group-think” to serve as an aegis to transient threats to the central role of the medical practitioner in historic and contemporary healthcare. Or at least physicians have. Professionalism, as a movement in medicine, arguably had its inception in this country with the organization of the American Medical Association (AMA). The AMA’s initial agenda included a proprietary defense to the threat of “irregular” practitioners—those from alternative medical education pathways. The central role of physicians in modern healthcare has been eroded by payers, the government, and the healthcare systems in which physicians find employment. Or so physicians think. In response, physicians have conveniently deployed “professionalism” as a shield against these threats, and the general threat of commercialism in medicine.1 Furthermore, professionalism has been nuanced, expanded and rolled out as a discipline to be taught in medical education in order to protect and retain a collective identity, resistant to oversight or intrusive engagement from the outside. The self-serving nature of the call for renewed professionalism and its incorporation into medical education is thinly veiled by the allure (and illusion) that it may actually be effective. All we are accomplishing is the depersonalization the very nature of the relationship between healer and patient upon which we “profess” our social vocation…
Professionalism cannot be taught. Medical educators do not know how to teach professionalism2 and medical students do not like to be taught professionalism.3 Students derive their professionalism from values, upbringing, and experiences prior to medical school. Additionally, residents at the end of their formal medical education define professionalism within the context of their day-to-day contact with patients. There is less emphasis on professionalism in the larger social context of medicine, which includes advocacy, collective self-effacement, self-governance, and ethical codes. Faculty members are distinctly challenged with teaching professionalism. Monitoring of peers serves as the prototypic challenge to faculty and private physicians, yet is almost universally recognized as a defining attribute of a profession.
But professionalism can be felt. This is what our students, our patients, and the society in which we practice are telling us. Fundamentally we all come to the healthcare table with a desire to feel, and receive, empathy. And empathy whether given or received can be a highly animating dynamic for professionalism.4 Nostalgia in turn allows reflection on what we recall as the “good” that we have experienced. Memories of our experiences harken respect, admiration, and longing for the best of previous times. Personal and “professional” nostalgia brings the narrative and heritage of the profession to a place of relevance, when placed with our past, present, and future patients in mind. Nostalgia inspires us and can promote creativity and optimism.5 Empathy and nostalgia, as sentiments, are lost in our drive to define, categorize, measure, and teach medical professionalism. And thus professionalism is reduced to a hollow and reactionary defense mechanism for physician dissatisfaction with modern health care.
What aspect of medical professionalism is truly professional? It must be personal and collective self-effacement. Our sentimentality, if we are careful not to lose it, can help us.
James Smith, MD, MA is Chair and Professor of Obstetrics and Gynecology at Creighton University School of Medicine and is involved in undergraduate and graduate medical education on a daily basis. He is currently a student in the graduate program at Loyola University Chicago Neiswanger Institute for Bioethics and has developed interests in the history of medicine and medical humanities.
- Hafferty F. Viewpoint: The elephant in medical professionalism’s kitchen. Acad Med 2006;81(10):906-14.
- Bryden P, Ginsburg S, Kurabi B, Ahmed N. Professing Professionalism: Are we our own worst enemy? Faculty members experiences of teaching and evaluating professionalism in medical education at one school. Acad Med 2010;85(6):1025-34.
- Baernstein A, Oelschlager AEA, Chang TA, Wenrich MD. Learning professionalism: perspectives of preclinical medical students. Acad Med 2009;84(5):574-81.
- Hegazi I, Wilson I. Maintaining empathy in medical school: it is possible. Med Teach 2013;35:1002-8.
- Sedikides C, Wildschut T. Past forward: nostalgia as a motivational force. Trends Cogn Sci 2016;20(5):319-21.