In addition to mastering medical skills, residents are expected to acquire the values of professionalism. These values include placing the needs of one's patients ahead of one's self-interest, being responsive to the needs of society, maintaining a commitment to scholarship, and enhancing the ability of all colleagues in the health profession to discharge their responsibilities optimally. Physicians must have the welfare of their patients as their primary professional concern. The resident must, therefore, demonstrate those humanistic qualities that foster the formation of appropriate patient/physician relationships. These qualities include integrity, respect, compassion, professional responsibility, courtesy, sensitivity to the patient's needs for comfort and encouragement, and an appropriate professional attitude and behavior toward colleagues.

Behaviors that challenge or diminish professionalism include abuse of power, arrogance, greed, misrepresentation, impairment, lack of conscientiousness, and conflict of interest.

Abuse of Power

The medical profession enjoys a high level of respect and this respect offers tremendous power to physicians. When used appropriately this power can accomplish enormous good and can establish a norm for behavior that is in society's best interest. Abuses of power can occur at several different levels. Appropriate respect for patients and colleagues is essential. Not allowing patients to voice their wishes or contribute to decision-making is an abuse of power. The gratuitous denigration of junior colleagues and other health professionals also represents an abuse of power. The profession has a responsibility to eliminate bias on the basis of disability, ethnicity, gender, age, race and religion. Breach of confidentiality represents an abuse of power. Patients trust that comments that are made as part of the patient/physician relationship will be held in strictest confidence. Casual comments or discussion of details of patients' situations in public (e.g., a crowded elevator or the cafeteria) represents an abuse of confidentiality.

Arrogance

Arrogance means an offensive display of superiority and self-importance. Arrogance denotes haughtiness, vanity, insolence and disdain. All of these qualities run counter to the demeanor of the professional.

Greed

When money becomes a driving force, greed predominates and professionalism is eroded. Greed can be defined as the inappropriate aspiration of fame, power, or money. When greed exists altruism, caring, generosity, and integrity are compromised. Physicians must continually ask themselves whether their actions are guided by the best interests of their patients or their own financial interests.

Misrepresentation

In the context of unprofessional behavior, misrepresentation consists of lying and fraud.

Impairment

Physicians who are impaired due to drugs, alcohol or mental impairment must relinquish their responsibility in caring for patients. Impaired physicians frequently cannot recognize their limitations and may not be able to acknowledge the existence of their impairment. Therefore, every physician is responsible for identifying impairment in a colleague. The natural reluctance to be the first person to draw attention to an impaired or potentially impaired colleague is a significant problem.

Lack of Conscientiousness

Lack of conscientiousness is a failure to fulfill responsibilities, and is incompatible with the essence of professionalism. Examples include, but are not limited to, failure to dictate medical discharges in a timely manner, failure to respond to pages and return phone calls, unwillingness to cooperate when needed for extra duty, failure to maintain up to date medical records and keep track of daily clinical results, and , in general, doing the minimum amount of work to get by.

Conflicts of Interest

Recognition and avoidance of conflicts of interest represent a core issue of professionalism. The physician must avoid situations in which the interest of the physician is placed above that of the patient. The personal acceptance of substantial gifts or subsidies from companies in exchange for undue influence is inappropriate professional behavior.

Adapted from Project Professionalism, American Board of Internal Medicine, 1995.

6/2001