Professionalism in medicine

1. What is Medical Professionalism?
Medicine’s contract with society
Ann Intern Med. 5 February 2002;136(3):243-246

2. Medical Professionalism Through the Centuries
Hippocratic Oath
5BC
The Oath of Maimonides
First printed in 1793
Physician’s Oath
WHO, 1948
Physician’s Pledge
SMC, 1995
Physician Charter*
2005

3. “The physician fills two roles in
society: healer and professional.”
Cruess SR, Johnston S, Cruess RL.
Professionalsim for Medicine: Opportunities and
Obligations. Iowa Orthop J. 2004; 24: 9–15.

4. Source: Drs R & S Creuss

5. What does medical professionalism
mean to medical students, residents,
academic faculty and patients?
All have three primary concerns:
Clinical competence
Patient Relationships
Character virtues
MEDICAL EDUCATION 2007; 41: 288–294

6. FACULTY RESIDENTS STUDENTS PATIENTS
Knowledge &
technical skill
Decisiveness &
being succinct
Reciprocity of
patient-doctor
relationship
Patient
relationships
Value of life
experience
Be available 24/7 Tone of voice &
body language
Dealing with stress Peer-based duty Need for superior
colleagues to
respect students
Help patients make
hard decisions
Power of resiliency Beyond normal
demands for
compassion
Caring, reassuring
compassionate ,
approachable &
give hope
Empowerment vs
authoritarianism
Might hurt
someone
Maturity Takes effort to
remain
compassionate
“See me, hear me,
feel with me & be
fair to us”
Importance of
other staff
members
Trust & spiritual
angst
Have time for
patients
Unique elements from the different focus groups

7. ―Care more for the individual patient than for
the special features of the disease. . . . Put
yourself in his place . . . The kindly word, the
cheerful greeting, the sympathetic look —
these the patient understands.‖
Sir William Osler
(1849-1919)
British (Canadian born)
Physician & Mentor

8. Medical professionalism
involves expectations and
obligations on both the
physician and society
Drs. Richard and Sylvia Cruess of McGill University
leaders in Medical Professionalism

9. Expectations: The Public & The Medical Profession
Patient’s/public’s expectation’s of doctors Medicine’s expectations of patients/public
Fulfill role of healer Trust sufficient to meet patient’s needs
Assured competence of physicians Autonomy sufficient to exercise judgment
Timely access to competent care Role in public policy in health
Altruistic service Shared responsibility for health
Morality, integrity, honesty Balanced lifestyle
Trustworthiness (codes of ethics) Rewards: nonfinancial (respect,status),
financial
Accountability/transparency
Respect for patient autonomy
Source of objective advice
Promotion of the public good
Perspectives in Biology and Medicine, volume
51, number 4 (autumn 2008): 579–98

10. We define medical professionalism as a set of
values, behaviours, and relationships that
underpin the trustthe public has in doctors
Working Party of the Royal College of Physicians
Clin Med. 2005 Nov-Dec;5(6 Suppl 1):S5-40.

11. Trust breaks down when expectations
are not met
Doctor lacks trust in patient when patient
doesn’t mention past medical history (especially if
deliberate)
Patient lacks trust in doctor when the patient
perceives a lack of professionalism

12. “Doctor is a pervert.
He kept staring at
my boobs.”
“Dr XXX is an impatient
person who talks very
loudly and is rude to me.
He doesn’t understand
the needs of the
patient…”
Dr very tactless…he
should evaluate his
calling to serve patients.
If this is not his vocation,
I suggest he go change
his trade. Apparently he
has no love in doing
what he is called to do.
Patient feedback
KTPH

13. SMC Ethical Code &
Ethical Guidelines

14. Application of SMC Ethical
Code in daily practice

15. Be dedicated to providing competent,
compassionate and appropriate medical
care to patients.
What do you do if you don’t know how to treat a
patient?
How do you remain compassionate when your last
patient turns up 30 minutes late for his appointment?

16. Be an advocate for patients’ care and well
being and endeavour to ensure that patients
suffer no harm.
Do you turn off life support in a brain-dead patient if the
relatives refuse?
Euthanasia & Physician-assisted death overseas and in
Singapore

17. Provide access to and treat patients without prejudice
of race, religion, creed, social standing, disability or
financial status.
A doctor shall also be prepared to treat patients on an
emergency or humanitarian basis when circumstances
permit.
 How do you give low income patients the best
treatment when they can’t afford it?
 What level of care do you give a foreign worker when
they need emergency care but cannot pay?
 Would you offer an active 71 year old aggressive
treatment for breast cancer?

18. Abide by all laws and regulations
governing medical practice and abide
by the code of ethics of the profession.
 What do you do if you face an ethical
issue you don’t know how to handle?

19. Maintain the highest standards of moral
integrity and intellectual honesty.
 How do you balance the needs of the patient
with the commercial needs of private
practice?
 A pharmaceutical companies wants to
sponsor your research on their drugs –
would you accept it?

20. Treat patients with honesty, dignity, respect
and consideration, upholding their right to be
adequately informed and their right to self
determination.
 Would you tell an alert elderly patient their
diagnosis if their family asked you not to?
 Your patient has terminal cancer and says
she doesn’t want any treatment to prolong
her life for another six months. What do you
do?

21. Maintain a professional relationship with
patients and their relatives and not abuse this
relationship through inappropriate personal
relationships or for personal gain.
 What would you do if there was mutual
attraction between yourself and your
patient (providing you were both single)?
 What if a patient left you a significant
amount of money in his will?

22. Keep confidential all medical
information about patients.
Your 70 year old expat (UK) patient is married to
a 50 year old Singaporean. The patient has been
diagnosed with stage IV cancer – who do you tell
the diagnosis to first?
Your 55 year old male patient has been
diagnosed HIV+ and won’t tell his wife. What do
you do?

23. “You need to look and behave like a doctor looks
and behaves, and just imagine what you would
like a doctor to look like if you were going to be
seeing them yourself.”
Professor Jane Dacre
Vice-Dean and Head of Education at UCL Medical
School, London & GMC Council Member

28. “The practice of medicine is an
art, not a trade; a calling, not a
business; a calling in which your
heart will be exercised equally
with your head.”
Sir William Osler
(1849-1919)
British (Canadian born) Physician & Mentor