What it means to be a professional

I came across an interesting article written in 1995 called The failure of organized health system reform—Now what?, written by George Lundberg, M.D., editor of The Journal of the American Medical Association from 1982–1999. He begins by reflecting on increasing efforts to regulate healthcare. Then he speaks to the role of professionalism in medicine. He has a perspective of what it means to be a professional that I had not heard before.

Dr. Lundberg explains the origin of professions by saying:

Professions evolved over time in response to human needs, as certain essential bodies of knowledge developed, and certain activities were deemed necessary, to serve as fundamental societal good. Such activities were set aside to be performed by those few people who became learned in each evolving profession. These persons came to be called professionals and, in the course of their work, they were afforded certain privileges. These privileges include gaining the most intimate knowledge of other human beings’ lives and bodies, in order to safeguard their welfare. Professionals are entrusted to use their special skills for the benefit of patients in the case of physicians, for clients in the case of lawyers, and for the laity in the case of the clergy.

Doctors, lawyers, clergy, and, to some extent, teachers belong to the classic learned professions, historically distinguished from trades and businesses. Although this distinction has been blurred in modern times, with many other groups being called professionals, one of the characteristics of a true profession remains its special relationship with the poor. Edmund Pellegrino has stated that a fundamental difference between a business and a profession is: “At some point in the professional relationship, when a difficult decision is to be made, you can depend on the one who is in a true profession to efface his/her own self-interest.”

Dr. Lundberg then argues that the failure of the medical profession to ensure that the poor receive medical care has been a driving force behind healthcare reform. The core of his argument is that no one likes to be micromanaged—certainly not physicians. But if professionals fail to manage and regulate themselves for the purposes of carrying out services essential to society, they will be managed and regulated by outside forces. He ends his essay by saying:

By definition, professions cannot function as interest groups because their primary interest must be the welfare of their patient (and populations of patients), clients, or the religious laity—the people who, in aggregate, the public gave the professionals the privileges and power they have. The primary concern of the professionals must not be the self-interest of the professional group or the corporation. If someday physicians and their organizations do become primarily self-interest groups, society—which has given them the privilege of being called professionals—will rise up and take that privilege away.

Dr. Lundberg places this argument in the context of ensuring that the poor have access to healthcare. But I see very strong parallels to the disclosure of medical errors. Both activities—providing care to the poor and disclosing medical errors—require physicians to put aside their own self-interest in order to act in the best interest of their fellow human beings.

So many times over the past nine months I have thought that my family’s proposed legislation is absolutely ridiculous. This is a bill with the sole purpose of establishing that the medical profession has a responsibility to be honest when a patient experiences an unanticipated outcome or medical error. Do we really need a law to establish this? Based on my family’s experience and the experiences of many other families, the answer is YES.

Take a look at the following statement, and try to guess which regulatory body wrote it:

It is a fundamental ethical requirement that a physician should at all times deal honestly and openly with patients. Patients have a right to know their past and present medical status and to be free of any mistaken beliefs concerning their conditions. Situations occasionally occur in which a patient suffers significant medical complications that may have resulted from the physician’s mistake or judgment. In these situations, the physician is ethically required to inform the patient of all the facts necessary to ensure understanding of what has occurred. Only through full disclosure is a patient able to make informed decisions regarding future medical care.

Hospital regulators? Government officials? Patients’ rights groups?

No. That is Opinion 8.12—Patient Information, from the Code of Ethics of the American Medical Association. It unambiguously states an obligation to disclosure medical errors. So strangely, the purpose of my family’s legislation is to establish that there is an obligation by medical professionals to act in a way that leaders of the medical profession have already established. The difference is that a code of ethics does not require compliance. A state statute does.

Once again, the words of Dr. Lundberg:

The primary concern of the professionals must not be the self-interest of the professional group or the corporation. If someday physicians and their organizations do become primarily self-interest groups, society—which has given them the privilege of being called professionals—will rise up and take that privilege away.

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