Professionalism, n. The status, methods, character, and standards of a professional.
We physicians are all members of the medical profession. We are not members of a medical club, a medical special interest group, or a medical fraternal order. As members of a profession, we are expected by society — not to mention each other — to act like professionals. This expectation is simultaneously a burden and a badge of honor and grace. To comport ourselves as professionals, we live by a code of conduct loftier than that which governs many other honorable fields of work. For clinicians in the medical arts and sciences, this is our blessing and our curse.
So, what exactly is professionalism? I meaningful, useful definition is hard to come by. But most of us have a pretty good sense of what professionalism entails.
First, it assumes a very high level of expertise and knowledge. Not only does medical information span a vast arena, it is constantly, often rapidly, changing. To wear the mantle of medical professional means we commit ourselves to a lifetime of study and continuing education. Intrinsic to this responsibility is that we have less personal or “free” time than those who opted to work in a less dynamic and volatile field. We knew this when we chose to enter the profession. It is a sacrifice we made willingly. A sophisticated style without the backing of wisdom may masquerade as professionalism, but is really the realm of the charlatan.
Second, while expertise is necessary, it is not sufficient for professionals. Equally important is character and demeanor. Professionals must remain above the fray of daily chaos, promoting balance and objectivity.
Indeed we are surrounded by turmoil. It is inherent in our work. Our mission is largely — though not exclusively — caring for people who are ill and distraught. They look to us to mend them where possible and to comfort them when healing is not an option. These demands can be overwhelming. Yet we have a duty to remain both calm and compassionate, to be rocks of stability while also resonating with the suffering of those who are ill and the joy of those who are well.
Yes, these are tough and often contradictory expectations. But medical professionals must strive to meet them. We have no choice. To rely on knowledge and expertise alone, untempered by character, may present a mirage of professionalism, but is really the realm of the intellectually aloof.
Finally, the consummate professional must always treat his or her fellow professionals with compassion and respect. In the medical profession, we each have a different expertise, knowledge base, and role to play. It is precisely for this reasons we must treat each other with courtesy and empathy. We are constantly “handing off” patients to each, primary care to specialist, specialist to specialist, specialist to primary care. The only way for professionals to succeed in this great relay is to admire the colleague who is handing you the patient and respect the colleague to whom you are handing the patient. Wisdom and character lose their luster in the absence of collegialty.
Linked to this last point is the importance of holding each other accountable. When we see that a colleague is, for whatever reason, not serving his or her patients well, we need to intervene in an appropriate way. We cannot turn away when we see mistakes, or suboptimal patient care by a colleague. It is beyond the scope of this piece to review different possible responses to a colleague who drops the ball, but we each know how to see such problems and how to get help with approaching them, in a professional way.
Professionalism requires constant attention and hard work. It does not come naturally or easily, not all the time. And no one is perfect, certainly not me. I could recite occasions when my professionalism took a vacation, episodes I am not proud of. There was the time I threw a patient’s chart at the wall as hard as I could in close proximity to some staff. There was the occasion I got very angry with an insulting, inebriated patient who had fallen off her horse, literally.
I try to keep these instances few and far between, but there are days when it takes strong will power. The stresses we face are legion — trying to fit more work into our days and nights than the hours available, juggling myriad competing priorities, constantly bearing bad tidings, spending much of our time listening to tales of woe and discontent. And let us not forget the need to reserve some energy for our families and after-work life. While these pressures can make our professionalism waver, we must resist the temptation. For myself, I always feel better after weathering particularly stormy days. Part of what helps me hew to the straight and narrow is the the unprofessional episodes from my past make me uncomfortable to this day.
No one said what we do would be easy. None of us took on long years of postgraduate education because we were seeking a stress-free was to earn a living. We entered this profession voluntarily, knowing the work week was long, the pressures high. But when the day is done, if we live and breathe as professionals, if we shoulder the challenges, the satisfactions can be immense. The gratitude of patients can nourish our souls. The thanks of colleagues can light a fire. And the respect, understanding, and love of our families can give meaning can give meaning like no other. The magic we work in the lives of those around us can be an endless source of awe.
Professionalism does have its rewards. Pause occasionally to relish them.
(June 2003)