Professionalism and Mental Health

1. Professionalism and Mental Health Cheryl S. Al-Mateen, MD, FAACAP, FAPADepartment of PsychiatryVCU School of Medicine

2. Overview • Professionalism – what is it? • Professionalism at MCV • Vignettes

3. Law Religion Medicine Nursing Occupational Therapy Psychology Recreation Therapy Social Work Learned Professions

4. The Oath of Hippocrates I do solemnly swear by that which I hold most sacred That I will be loyal to the profession of medicine and just and generous to its members That I will lead my life and practice my art in uprightness and honor That into whatsoever house I shall enter it shall be for the good of the sick to the utmost of my power, I holding myself aloof from wrong, from corruption, from tempting of others to vice That I will exercise my art solely for the cure of my patients, and will give no drug, perform no operation, for a criminal purpose, even if solicited, far less suggest it That whatsoever I shall see or hear of the lives of men which is not fitting to be spoken, I will keep inviolably secret…….

5. Psychology General Principles Beneficence and nonmaleficence Fidelity and responsibility Integrity Justice Respect for people’s rights and dignity Ethical standards Resolving ethical issues Competence Human relations Privacy and confidentiality Advertising Record keeping and fees Education and training Research and publication Assessment Therapy

6. Social Work Ethical principles primary goal is to help people in need and to address social problems challenge social injustice respect the inherent dignity and worth of the person recognize the central importance of human relationships behave in a trustworthy manner. practice within their areas of competence and develop and enhance their professional expertise Ethical standards Responsibilities to clients Responsibilities to colleagues Responsibilities in practice settings Responsibilities as professionals To the profession To broader society

7. American Psychiatric Nurse’s Association/American Nurse’s Association • Provision 1. …practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. • Provision 2: ...primary commitment is to the patient, whether an individual, family, group, or community. • Provision 3: promotes, advocates for, and strives to protect the health, safety, and rights of the patient. • Provision 4: is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse's obligation to provide optimum patient care

8. American Nurses’ Association, cont’d • Provision 5: owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. • Provision 6: participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collective action. • Provision 7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. • Provision 8. The nurse collaborates with other health professionals and the public in promoting community, national, and international efforts to meet health needs.

9. American Therapeutic Recreation Association • Beneficence/non-maleficence • Autonomy • Justice • Fidelity • Veracity/Informed Consent • Confidentiality and Privacy • Competence • Compliance with Laws and Regulations

10. Occupational therapy Occupational therapy personnel shall… • demonstrate a concern for the well-being of the recipients of their services (beneficence) • take reasonable precautions to avoid imposing or inflicting harm upon the recipient of services or to his or her property (nonmaleficence) • respect the recipient and/or their surrogates as well as the recipient’s rights (autonomy, privacy, confidentiality) • achieve and continually maintain high standards of competence (duties) • comply with laws and Association policies guiding the profession of occupational therapy (justice) • provide accurate information about occupational therapy services (veracity) • treat colleagues and other professionals with fairness, discretion, and integrity (fidelity)

11. ACGME • Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population

12. Charter on Medical Professionalism • Professionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health. The principles and responsibilities of medical professionalism must be clearly understood by both the profession and society. Essential to this contract is public trust in physicians, which depends on the integrity of both individual physicians and the whole profession.

13. Principles Primacy of patient welfare Patient autonomy Social justice Commitments Professional competence Honesty with patients Patient confidentiality Maintaining appropriate relations with patients Improving quality of care Improving access to care Just distribution of finite resources Scientific knowledge Maintaining trust by managing conflicts of interest Professional responsibilities Charter on Medical Professionalism

14. Professionalism at MCV

15. The AMA Council on Ethical and Judicial Affairs (1980) A physician shall… • be dedicated to providing competent medical service with compassion and respect for human dignity. • be honest with patients and colleagues and strive to expose those physicians deficient in character or competence or who engage in fraud or deception. • respect the law and a responsibility to seek changes in those requirements that are contrary to the best interests of the patient. • respect the rights of patients/colleagues and of other health professionals and shall safeguard patient confidences within the constraints of the law. • continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues, and the public, obtain consultation and use the talents of other heath professionals when indicated. • in the provision of patient care, except in emergencies, be free to choose whom to serve, associate with, and the environment in which to provide medical services. • recognize a responsibility to participate in activities contributing to an improved community.

16. Sources of Concern re: Professionalism • Medical student graduation questionnaire • AMA • AAMC • ACGME • LCME • ABIM • Local anecdotes

17. VCU SOM Professionalism Task Force Report - 2001 • Reviewed definitions • Assess MCV campus environment • Develop goals for enhancing MCV environment • Assist Dean’s office in maintaining professionalism

18. VCU SOM Professionalism Task Force Conclusions and Tasks • All unprofessional behavior is unacceptable….corrective actions will be necessary • Enhancing professionalism among the faculty, who serve as role models for others, will have a beneficial effect on these groups • There is limited evaluation of individual faculty members and students of professionalism in our school. A new series of evaluation processes is necessary • We need specific policies to deal with transgressions in professionalism • We need coursework on professionalism • A program to increase the awareness of medical professionalism in the entire community of VCU SOM

19. Components of Medical Professionalism • Altruism • Accountability • Excellence • Respect for others • Personal commitment to life-long learning • Duty • Honor and integrity (KUMC definition)

20. Abuse of power Discrimination Bias Breach of confidentiality Arrogance Greed Misrepresentation Impairment Lack of conscientiousness Conflict of interest (KUMC definition) Challenges to Professionalism

21. Unprofessional Behavior • Unmet professional responsibility • Lack of effort toward self-improvement and adaptability • Poor interaction with patients and families • Inappropriate relationships with health care professionals

22. Teacher-learner relationship • Mutual trust • Respect • Responsibility • Professional manner • Focus on education • High quality patient care • Ethical conduct.

23. Vignettes

24. A patient witnesses her kitten being mauled and killed by a pit bull. She is in significant distress. She has taken a picture of the cat for legal purposes. She has come to you for treatment of anxiety symptoms. She wants to show you the pictures, indicating that she feels you cannot understand the depth of her grief without seeing the pictures.

25. Tape Vignettes How could this situation present in mental health training? How should it be handled?

26. VCU School of Medicine Standards of Professional Behavior These standards describe behaviors expected from faculty, housestaff, and students in the School of Medicine: • Recognize their positions as role models for other members of the health care team. • Carry out academic, clinical and research responsibilities in a conscientious manner, make every effort to exceed expectations and make a commitment to life-long learning.

27. Treat patients, faculty, housestaff and students with humanism and sensitivity to the value of cultural, social, age, gender, disability and economic diversity without discrimination, bias, or harassment. • Maintain patient confidentiality. • Be respectful of the privacy of all members of the medical campus community and avoid promoting gossip and rumor. • Interact with all other members of the health care team in a helpful and supportive fashion without arrogance and with respect and recognition of the roles played by each individual.

28. Provide help or seek assistance for any member of the health care team who is recognized as impaired in his/her ability to perform his/her professional obligations. • Be mindful the limits of one’s knowledge and abilities and seek help from others whenever appropriate. • Abide by accepted ethical standards in the scholarship, research and standards of patient care. • Abide by the guidelines of the VCU Honor System.

29. “Bottom Line” Medical Professionalism is an expected behavior in all interactions • Faculty • Housestaff • Support staff • Students

32. Professionalism:  accepting responsibility for continuity of care, respect, compassion, ethics, integrity, cultural and ethnic sensitivity Options: Unsatisfactory Below Expectations, Needs Remediation Meets Expectations Exceeds Expectations

33. Faculty Evaluation for Professionalism ?

35. Professionalism Committee Process Discuss/guidance Modified Informal Complaint Refer Student Housestaff Faculty Professionalism Committee

36. School of medicine professionalism contact committee • Dr. Karen Sanders (Chair), VAMC • Dr. Cheryl Al-Mateen, Psychiatry • Dr. Diane Biskobing, Internal Medicine • Dr. Melissa Bradner, Family Medicine • Dr. Jan Chlebowski, Graduate Education • Dr. Ron Clark, Internal Medicine • Dr. Ray Colello, Anatomy • Dr. Philippe Girerd, OB/GYN • Carol Hampton, Faculty and Instructional Development • Dr. Walter Lawrence, Surgery • Dr. Joyce Lloyd, Human Genetics • Dr. James Messmer, Undergraduate Medical Education • Dr. Mary Alice O’Donnell, Graduate Medical Education • Dr. Andrea Pozez, Surgery • Dr. Elizabeth Waterhouse, Neurology

37. SOM Professionalism Website http://www.medschool.vcu.edu/professionalism/