<aside> 💡 Professionalism in Clinical Practice

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1. Outline the features of ‘professional’ disciplines and why professionalism is so important to the practice of medicine
   • Profession
     • Occupation whose core element of work is based on a mastery of complex knowledge and skills used in the service of others: has specific responsibilities
   • Professional
     • Someone who you can trust when no one is looking
       • Patients need to know you are committed to their best interest when they are at their most vulnerable
   • Members of a profession have a commitment to:
     • Competence
       • Expert advice on public health
       • Set/maintain standard of competency/integrity
       • Provide complex skills/services to society
     • Integrity
       • Honest
       • Moral
       • Consistent
       • Incorruptible
       • Takes years to build, seconds to loose!
     • Morality
     • Altruism
       • Putting individual patients' interests first above your self-interest - meet patient's needs before your own
     • Promotion of Public Good: serving needs of community as whole
       • Responding to / addressing concerns of society
       • Responsible use of resources
       • Maintaining health of public
   • Professionalism importance in medicine
     • Professionalism underpins public trust in doctors
     • Trust binds social contract:
       • Societal expectations of doctor, and privilege granted in return to doctors by society
         • Enable professional self regulation:
           • Ensure services are competent and ethical - regulate medical practice
           • Self regulation comes with many benefits to professions
             • Practice without supervision
             • Accountability for one’s own actions
             • Minimal external influence
             • Good relationship with government and law
             • Prestige/public trust
           • Self regulation comes with many benefits to the public
             • Efficient/cheap; maintenance of standards by profession not taxpayers
             • Professions best to maintain specialized standards
             • Insulates government from actions of professional
             • Self-regulation is incomplete/external regulation required for some activity (prescribing medications)
             • Mechanism for public accountability (appointing public on regulatory boards)
           • Failure of professionalism erodes social contract
             • Loss of self regulation and autonomy
             • Bristol heart scandal:
               • Incompentent cardiac pediatric surgeon incompetence lead to deaths of many children
               • Investigation lead to loss of self regulation/autonomy
                 • UK medical board now contains more members of public to doctors
     • Professionalism in daily interactions
       • Serving patients (altruism)
       • Respect patients autonomy
       • Promote social justice (fairness)
       • Competence/scientific
       • Honesty (disclosure and consent)
       • Confidentiality
       • Professional boundaries
       • Improving quality/access
       • Equitable distribution
       • Conflict of interest
       • Responsibility
2. Discuss the responsibilities that come with the privilege of being a doctor making reference to the ‘social contract’
   • Social contract:
     • Medical profession is given prestige, autonomy, self-regulation, and rewards in expectation of professionalism
     • Trust binds the social contract
       • Firm belief in the reliability, truth or ability of someone
       • Outcome of professionalism
       • Fundamental to patient doctor relationship
       • Ill must believe you have their best interest
     • Responsibilities
       • Placing interests of the patient above those of the physician
       • Setting and maintaining standards of competence and integrity
       • Providing expert advice to society on matters of health
       • Being a 1st year medical student
         • Patient confidentiality
         • Time management: be punctual
         • Politeness and respect for all staff and patients
         • Personal appearance: communicates a non-verbal message about you
           • Stretching norms creates barriers with peers and patients
         • Awareness of your scope: relevant to yearly learnings
     • Society grants:
       • Autonomy in practice
         • Freedom to make independent decisions in best interest of patient/society
         • Exists b/c of oversight of peer/professional evaluation
       • Self-regulation
         • Profession allowed to set rules to protect public
         • Standards to enter profession (education/accreditation)
         • Standards of practice (licence, medical board, clinical standards)
         • Medical Board of Australia regulates Australia's medical practitioners
         • AHPRA
       • Prestige
     • Failure of professionalism erodes social contract
3. Discuss the importance of maintaining patient confidentiality, especially as a feature of professionalism
4. Describe the elements of truly informed consent, and best practice in obtaining informed consent from patients
5. Discuss how professionalism is applied in our everyday clinical interactions with patients, with other health professionals, and with broader community members
6. Explain the pressures that may influence clinical decision-making, and professionalism using pharmaceutical marketing as an example.