Medicine considers what defines professionalism

AMA Wire
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Physicians take an oath to uphold ethical standards, but rapid changes in the health care system may have begun to blur lines across the practice of medicine. What measures should physicians be held accountable to, and who should regulate the profession?

The May 12 issue of JAMA takes a deep dive into professionalism, including Viewpoints from scholars and academic leaders about the responsibility and accountability of medicine to self-govern, self-regulate and ensure the highest degree of professionalism.

Prominent physicians among the authors include AMA Executive Vice President and CEO James L. Madara, MD; Ezekiel J. Emanuel, MD, vice provost for global initiatives and chair of the department of medical ethics and health policy at the University of Pennsylvania; Thomas J. Nasca, MD, CEO of the Accreditation Council for Graduate Medical Education; and Lois Margaret Nora, MD, president and CEO of the American Board of Medical Specialties.

The issue examines the key roles and responsibilities of modern governing and accrediting bodies and of professional organizations and societies. Find out what these entities are doing—and what they should do differently—to enhance self-governance, safeguard self-regulation and foster professionalism.

Instilling professionalism

Where does the foundation for professionalism begin? According to one JAMA Viewpoint, it’s laid before medical school, and undergraduate medical education reinforces the commitment to professionalism. This piece holds that developing competence in professionalism is a core expectation for a physician learner, the same as developing competence in medical knowledge.

On a related note, this month’s issue of the AMA Journal of Ethics tackles this topic. The issue examines where professional boundaries start and stop, and how far physicians may go to assist patients with nonclinical matters.

Earn continuing medical education credit and investigate professional boundaries further by using a module from the AMA’s Council on Ethical and Judicial Affairs. Learn about key areas where establishing boundaries with patients may be challenging and issues outside the patient-physician relationship where boundaries are essential.

Continuous learning and self-regulation

Professionalism and lifelong learning go hand-in-hand, which gives way to professional self-regulation, according to another JAMA Viewpoint. Topics up for discussion include maintenance of certification and reforming the continuing medical education system.

With the increasing proportion of physicians employed by health care systems, what is the role of employers in governing and overseeing professionalism among physician-employees? Another JAMA Viewpoint explores how employment can advance or detract from professionalism goals.

Finally, the JAMA Viewpoint by Dr. Madara asks how physician and professional organizations can assist in professionalism. One way is to understand physicians’ intrinsic motivators and help craft environments that leverage these motivators. 

Read an editorial outlining all of these topic areas and view the list of 19 Viewpoints.

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The ethical standards we are taught in Medical School is contradicted by our employers /groups/HMOs when we get into practice. The only way to have chief concern for the patient is to practice solo, have low overhead and balance the wealthy patients against the Medicaid patients so that we can afford to treat all with the same care and diligence.<br/> When I was an ER doc I got pressure to take hypoxic grandmothers with pneumonia and send them home, to not do good work ups that included lab work that costed more money because I knew how to work up a zebra starting in the ER. <br/> <br/> In fact the less intellectually capable the doctor , the less he would know to order and the more praise he would receive from the HMO! Not realizing how poor the treatment or work up was was actually a characteristic encouraged by HMO's. There is only personal satisfaction for doing a great job, finding the diagnoses that no one else did or pushing the surgeon to take out the appendix at 2 am instead of 10 to prevent rupture. <br/> <br/> The JAMA articles were fair but in my opinion skim the surface of what we really think as working docs. I am now educating on the subject of getting to the cause of why someone is ill by looking into more factors than we usually do -- including environmental exposure, hormonal and neurologic affects on the ANS as consequences of that exposure and I hope that one day ethics in medicine allows clinicians with important information to get it into print in JAMA etc. Not all is Pharma friendly, until the ethicists talk more about taking the advertising of Pharma out of the journals we will never have a fair look at these issues. I support Catherine DeAngelis for her previous work in this area. Sincerely., Lisa Nagy <a href="" rel='nofollow'></a>
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Nov 15, 2018
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