Srinivasan M. Medical Professionalism: More Than Simply a Job. JAMA. 1999;282(9):814Z. doi:10.1001/jama.282.9.814
Prepared by Ashish Bajaj, Department of Resident
Physicians Services, American Medical Association.
As physicians, we have all seen disrespectful and antagonistic behavior
exhibited by colleagues. Egregious unprofessional behavior, like exemplary
behavior, is almost always apparent to patients, colleagues, and other observers.
I can remember long call nights when I spoke about patients in disparaging
ways or became provoked and did not uphold my personal standards. During those
moments, my behavior fell short of the professional standards I had pledged
I am not alone in my lapses. In one institution, approximately 20% of
anesthesia residents were cited for unprofessional behavior by their attending
physicians during rotation evaluations.1
Other studies have demonstrated that these behaviors occur up to once an hour,2 and that when they do occur, they are often ignored.3
We can change the learning climate to reinforce professional behaviors,
such as respect, compassion, altruism, accountability, service, and life-long
learning. Research has demonstrated that behavioral patterns can be taught.4 To help create better physicians educators should:
Reinforce positive behavior by rewarding models of exemplary patient
care and collegial respect. I once observed a pulmonary chief of service keep
his cool when another service challenged his patient care decisions, then
explain why his antibiotic choice was appropriate, and—most importantly—compliment
the acumen of the other team after they had left.
Address negative behavior through existing educational modules
for improving teachers' ability to address unprofessional behaviors in nonpunitive
ways that can lead to improved learner behavior.5
We should also promote the development of new models.
Address underlying issues by improving working conditions, providing
adequate time off, and protecting learning time—all important components
that show a commitment to teaching and learning. Improving the working environment
will promote professional attitudes.
Set superb examples by modeling compassionate patient care, active
community/professional service, and honest collegial respect. Despite provocations
or burnout, physicians must learn how to maintain presence of mind, always
use professional language, and act in a professional manner.
Professionalism is integral to the practice of medicine. The foundations
of our collective professionalism are being severely tested by major changes
in both medical education and the health care marketplace. But the challenge
to behave professionally is also a personal test that occurs daily, in increments.
Whenever my patience is taxed and I feel unable to maintain my equilibrium,
I try to view myself through the eyes of my students and patients. Each day
I ask myself the question that tests my professionalism, "Can I be proud of
who I appear to be?" With any luck, it's a test I'll pass.