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Wednesday, June 06, 2007

What Happened to Professionalism?

I have long believed that a change in the culture of medicine would be a difficult but essential part of health care reform.

For that reason, I was encouraged to read an opinion piece in the May 7, 2007 issue of Modern Healthcare as authored by Chalmers Nunn, M.D., President of the American College of Physician Executives and Medical Director of Clinical Informatics at Centra Health in Virginia.

Nunn bemoaned the slow pace at which progress is being made in the improvement of safety and quality. He said that physicians had to accept standardized care. He called for increased personal and professional development of physician leaders. He pointed out that clinicians needed to “learn a new way of thinking, a new way of approaching care and a new way of being doctors.” He talked about the need for physicians to develop the ability to “listen, negotiate and partner with others.”

But I was then brought up short by this statement: “Whether it’s additional pay for improving safety, or additional benefits such as more time off, physicians, nurses and others need tangible incentives to help them engage in quality initiatives.”

I have always thought that professionalism meant putting client interest ahead of personal interest. I’ve assumed that professionals were granted independence of action because they could be counted on to do the right thing.

Nunn seems to be saying that these understandings no longer apply and that health professionals can’t be counted on to serve the best interests of patients unless they are given some tangible incentive to do so.

Does that mean that in order to have confidence in my physician, I need to be sure that my insurance company or her employer is giving her extra pay or time off in return for doing what is best for me?

Sadly, I think there is something in what Nunn is saying. I can no longer count on my doctor to do the right thing because she is a professional. In my own case I am sure she will, but Nunn suggests that I can’t count on it.

I think it means that health care professionals have to be brought under the institutional oversight of institutions, such as hospitals or group practices, that are held accountable for the performance of the professionals they supervise. It means that we have to learn to put our confidence in institutions rather than in individuals.

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