Medical Professionalism

1. Medical Professionalism Richard de Ferrars Frimley GP VTS

2. Professionalism? What does “professional” mean? Sports - means getting paid Work - means more than that Suggestions? Can I teach you to be professional? Yes or No?

3. Professionalism? • A professional is a member of a vocation founded upon specialised educational training. • The word professional traditionally means a person who has obtained a degree in a professional field.

4. Professionalism? • Academic qualifications - teaching, engineering, medical, or law degree • Expert and specialised knowledge -in field which one is practicing professionally • A high standard of professional ethics -behaviour and work activities while carrying out one's profession • Work morale and motivation -Having interest & desire to do job well.Holding positive attitude towards the profession.

5. Professionalism? What does “professional” mean? Sports - means getting paid Work - means more than that • Academic qualification • Specialised knowledge • Professional ethics • Work morale & motivation UK – professional bodies usually have a Royal Charter.

6. What is Medical Professionalism? • Academic qualification • Specialised knowledge • Professional ethics • Work moral & motivation Medical Professionalism Is there more to it than this? Discuss & comment please.

7. What is Medical Professionalism? “Professionalism is a basket of qualities that enables us to trust our advisers.” • Dame Janet Smith (Who is she?) “Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors.” • Royal College of Physicians Academic qualification Specialised knowledge Professional ethics Work morale & motivation

8. What is Medical Professionalism? “Professionalism is a basket of qualities that enables us to trust our advisers.” • Dame Janet Smith (Who is she?) “Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors.” • Royal College of Physicians Two way process: Not just our perception of ourselves Also public perception and trust of us Academic qualification Specialised knowledge Professional ethics Work morale & motivation

9. Professionalism - Where Can I Get Some? • Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors. What determines your own model of professionalism? • Cultural norms (public) • Professional duties (GMC) • Own professional values (personal) Academic qualification Specialised knowledge Professional ethics Work moral & motivation Public trust

10. Ethics - Where Can I Get Some? • Medical ethics is primarily a field of applied ethics, the study of moral values and judgments as they apply to medicine. • What determines your own “individual” ethics? • Cultural norms (public) • Professional duties (GMC) • Own moral values (personal)

11. 1) Professionalism – Cultural Norms • Who here has lived for considerable periods in another country? • Who here has studies/ worked as a doctor in another country? • How does the publics perception and expectation of a doctor differ from what you have seen so far in the UK? • Cultural norms vary from place to place

12. 1) Professionalism – Cultural Norms • Who here has heard a senior colleague mutter “it wasn’t like that in my day and age”? Are they a grumpy old git? Or are you young and irresponsible? (need to consider “generational differences”….)

13. Totally committed to the ‘company’ Horrified by unemployment Would go down with the ship Typified by unquestioning loyalty Place more importance on career than personal life Mistrustful and suspicious of employers Usually had experience of many jobs Not committed to a particular company Want immediate gratification Workaholics Accept stress as part of the job Used to belt tightening and sacrifice Value titles and status symbols Want a balance of work and personal life Take time off for personal life enhancement Demand flexible environments and benefits Do not expect a job for life Expect and get immediate reward Which Are You? Which Am I?

14. Types of Workers • Traditionalists • Baby boomers • Generation X • Generation Y

15. Pre 1946 Traditionalists • Totally committed to the ‘company’ • Horrified by unemployment • Would go down with the ship • Typified by unquestioning loyalty Academic qualification Specialised knowledge Professional ethics Work morale & motivation Public trust

16. 1947- 1972 Baby Boomers • Workaholics • Accept stress as part of the job • Used to belt tightening and sacrifice • Work predicated on delayed gratification • Value titles and status symbols Academic qualification Specialised knowledge Professional ethics Work morale & motivation Public trust

17. 1968 – 1980 Generation X • Still place more importance on career than personal life • More suspicious of employers • Products of downsizing and cost cutting • Usually had experience of many jobs (flexibility) • Working more for now (immediate gratification) Academic qualification Specialised knowledge Professional ethics Work morale & motivation Public trust

18. 1980 – 1995 Generation Y • Want a balance of work and personal life • Take time off for personal life enhancement • Demand flexible environments and benefits • Do not expect a job for life • Expanding job market and shrinking work force • Expect and get immediate reward Academic qualification Specialised knowledge Professional ethics Work morale & motivation Public trust

19. 1) Professionalism – Cultural Norms • Who here has heard a senior colleague mutter “it wasn’t like that in my day and age”? Are they a grumpy old git? Or are you young and irresponsible? (need to consider “generational differences”….) Cultural norms vary over time

20. Professionalism - Where Can I Get Some? • Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors. • What determines your own view of professionalism? • Cultural norms (public) • Professional duties (GMC) • Own professional values (personal)

21. Totally committed to the ‘company’ Horrified by unemployment Would go down with the ship Typified by unquestioning loyalty Place more importance on career than personal life Mistrustful and suspicious of employers Usually had experience of many jobs Not committed to a particular company Want immediate gratification Workaholics Accept stress as part of the job Used to belt tightening and sacrifice Value titles and status symbols Want a balance of work and personal life Take time off for personal life enhancement Demand flexible environments and benefits Do not expect a job for life Expect and get immediate reward Which is the GMC?

22. 2) Professionalism – The GMC • More Baby Boomer than Traditionalist? Judge Dredd Judge, jury & executioner “The crime is life, the sentence is death….” Commonest reason?

23. Totally committed to the ‘company’ Horrified by unemployment Would go down with the ship Typified by unquestioning loyalty Place more importance on career than personal life Mistrustful and suspicious of employers Usually had experience of many jobs Not committed to a particular company Want immediate gratification Workaholics Accept stress as part of the job Used to belt tightening and sacrifice Value titles and status symbols Want a balance of work and personal life Take time off for personal life enhancement Demand flexible environments and benefits Do not expect a job for life Expect and get immediate reward Which is your Consultant/ ES?

24. Totally committed to the ‘company’ Horrified by unemployment Would go down with the ship Typified by unquestioning loyalty Place more importance on career than personal life Mistrustful and suspicious of employers Usually had experience of many jobs Not committed to a particular company Want immediate gratification Workaholics Accept stress as part of the job Used to belt tightening and sacrifice Value titles and status symbols Want a balance of work and personal life Take time off for personal life enhancement Demand flexible environments and benefits Do not expect a job for life Expect and get immediate reward Which Does THIS Patient Expect?

25. Expectation of Professionalism What determines your own model of professionalism? • Cultural norms (public) • Professional duties (GMC) • Own professional values (personal) • Cultural norms vary from place to place • Cultural norms vary with time • Expectation of others will vary • Professional duties are clear (Judge Dredd) Where do you go for a statement of your professional duties?

26. Professionalism - Where Can I Get Some? • Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors. • What determines your own view of professionalism? • Cultural norms (public) • Professional duties (GMC) • Own professional values (personal)

27. 3) Personal Professional Values • A patient wants to make a claim on a sickness insurance policy for back pain. He had an episode 5 years ago which he forgot to declare. He asks you to omit this when completing the form. • Is this acceptable? • Do you know doctors who would bend the truth when making claims themselves? • Do you know doctors who would keep the change if given too much by accident at the shops?....

28. Professional Duties - GMC What does GMC guidance say? 56. Probity means being honest and trustworthy, and acting with integrity: this is at the heart of medical professionalism. 57. You must make sure that your conduct at all times justifies your patients' trust in you and the public's trust in the profession READ GOOD MECICAL PRACTICE.

29. 3) Personal Professional Values • You find your Registrar a bit of a struggle. He seems easy to irritate, especially when under pressure. On-call last night, he has a real go at the F1 about a clerking and then was rude to one of the nurses. • Is this acceptable? • Do you know doctors who “kick the cat”? • Have you ever bitten off someone’s head unjustifiably? • What should you do in this situation – something or nothing?....

30. Professional Duties - GMC What does GMC guidance say? 46. You must treat your colleagues fairly and with respect. You must not bully or harass them, or unfairly discriminate against them by allowing your personal views* to affect adversely your professional relationship with them.You should challenge colleagues if their behaviour does not comply with this guidance. READ GOOD MECICAL PRACTICE.

31. 3) Personal Professional Values • I am an ST1 in A&E I wake up with a headache, feeling knackered and a bit giddy….. • Should I go into work? • What has happened to rates of sickness in junior doctors since EWTD saw hours of work almost halved? • Is there a difference between sickness rates for STs in hospital and STs in GP placements?

32. Professional Duties - GMC What does GMC guidance say? • Patients need good doctors. Good doctors … act with integrity. 79. If you know that you have, or think that you might have, a serious condition that you could pass on to patients, or if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. (Largely “your call” – statistics speak for themselves…) READ GOOD MECICAL PRACTICE.

33. 3) Personal Professional Values • You are working in A&E. You have been seeing a patient with a severe nose-bleed. You are helping the Consultant with packing. The time is 18:00, the end of your shift. What do you do? • Walk away? • Ask him to call for another pair of hands? • What would he expect you to do?....

34. Professional Duties - GMC What does GMC guidance say? The duties of a doctor…. • Make the care of your patient your first concern 41. Most doctors work in teams with colleagues from other professions. Working in teams does not change your personal accountability for your professional conduct and the care you provide READ GOOD MECICAL PRACTICE.

35. In Summary…. • Medical Professionalism is a mix of: • Own professional values (personal) • Professional duties (GMC) • Cultural norms (public expectation) • Professionalism changes over time • Professionalism is culture-sensitive • In each context, you should consider the expectation of others (colleague or patient)

36. The End