Viewpoint
Make Professionalism a Priority
Being a physician is a privilege. Nothing compares with the reward of being able to diagnose and treat disease—sometimes curing and sometimes ameliorating symptoms. Sometimes patients say thank you, sometimes they don’t. Sometimes patients actively help with diagnosis and treatment; other times they don’t. But generally, we are highly regarded for using our medical and scientific knowledge to promote the health interests of our individual patients and the general health of the public.
We know that the honor granted our profession comes with significant obligations sometimes referred to as “professionalism.” Professionalism encompasses ethical ideals that are at the heart of our relationship with our patients. Physicians traditionally have thought about professionalism in terms of the welfare of the individual, and since ancient times, patients have trusted us to put their welfare ahead of our own. Today, however, with rising health care costs, limited resources, growing disparities in care for certain populations, people without insurance, and inadequate Medicare reimbursement, we are challenged to define professionalism within a complex health care system.
One of the MMA’s goals is to help our members do this. Last spring, we convened a Professionalism Work Group to set some priorities. We used as our framework for discussion the article “Medical Professionalism in the New Millennium: A Physician Charter” from the February 5, 2002, issue of the Annals of Internal Medicine. The charter, developed by the American Board of Internal Medicine Foundation, the American College of Physicians, and the European Federation of Internal Medicine, lists three fundamental principles of medical professionalism:
The primacy of patient welfare. Physicians ought to be dedicated to serving the interest of the patient. The principle asserts both beneficence (doing what is good) and nonmalfeasance (avoiding what is bad) and implies that altruism contributes to the trust that is central to the physician-patient relationship.
Patient autonomy. This principle requires that physicians be truth-telling and honest with their patients in order to empower them to make informed decisions. A corollary to this principle is that physicians not support decisions that are not in keeping with ethical practice or that are demands for inappropriate care.
Social justice or fairness. Physicians should work for fair distribution of health care resources and to eliminate discrimination in health care based on social category.
After extensive discussion about these principles, our work group recommended to the Board of Trustees that the MMA focus on the following: returning economic control to the patient, ensuring that appropriate care is delivered (not too much or too little) and supporting the just distribution of resources and use of capital. In addition, the work group recommended that the MMA continue to work on continuous learning by cultivating relationships with medical schools and graduate medical education programs, giving back to the community, and strengthening connections with professional societies and organized medicine.
Promoting professionalism is as important now as it has ever been. The problems we face challenge our profession but must not affect our professionalism. Our association and we, as individual physicians, must strive toward the highest levels of professionalism that we are able to attain.
I look forward to this year of service as your president. If you have thoughts or concerns, please do not hesitate to contact me through the MMA office at mm@mnmed.org or 612/362-3875.