In the ten years since I began blogging much of what has been written about medical professionalism, I find alarming. The New Professionalism as promulgated by the American College of Physicians and the ABIM attempts to transform the basic medical obligation of the physician to the patient to a nebulous,operational vague co-duty to serve society by conserving resources and furthering social justice.
The following is taken from an earlier blog entry with light editing and additions.
Dr. Lawrence G.Smith, writing in the April 3, 2005 issue of
the American Journal of Medicine speaks of this transformation. from lay person to physician.
Professionalism has been written about extensively as it relates to
doctors. Smith maintains the core of professionalism is the "personal transformation
of self that takes place in stages during the early years of medical
training and practice" When transformed the person now interacts with
society in a new and different manner ).Dr. Smith was not speaking of professionalism in terms of being a steward of collectively owned resources,that distortion of basic medical ethics was not then widely written about.
I have no doubt
that transition happened to me. I can still remember comments made by teachers now
over 50 years ago which were part of that process. I remember the
attitude of respect and seriousness that was passed to me from the
professors of gross anatomy as it related to behavior to the cadavers
and behavior in the lab. I remember the pathology professor who told us
that when we saw patients at night in the hospital how important it was
for us to look and behave like physicians.I remember the chief of
surgery who insisted that his residents wear shirts and ties in the
hospital and clean coats and that his definition of a surgeon was a
physician who knew how to operate.I remember how the clinical faculty
typically treated the patients in the county hospital always with
courtesy and respect, even though at times residents might have not.
Soon after I completed residency and fellowship training I was doing a locum
tenens and had the occasional to call the chief of medicine, with whom I
had trained, to see a private patient at 3 am. She had end stage lupus
and he had seen her several years before and her parents insisted that he see them. I called him at home and he arrived soon after .. He was well shaven and well dressed in a suit and tie.. He spent
over a hour with the patient and family,taking a detailed history and ding a physical examination , completed a page and half note
and spent another 10 minutes with me.The family was greatly relieved
that all that could be done was being done. I was greatly relieved and
felt that the chief had taught me another lesson;how a physician can do
things the way that should be done in the real world.
are just a few snap shots of the many events and attitudes that lead to my
transition from a college kid who really had no idea what to expect in
med school or beyond to a person who felt he was trained to do serious,
often difficult, important work and that it all was a privilege and a
great obligation and that doing the right thing for the patient was what
it was all about. Much of what my high school friends had done while I
was in training, I had missed and in the years of training much of
transpired in the world I had also missed. And much of the everyday
concerns of relatives seemed to be so much less important.I believe part
of that transformation process is the isolation from the daily events
of the world that seems required by the intense study and training
lasting for years past the usual time an adult joins the work force.
Part of that transformation occurs because most of your waking hours are
spent with other physicians and professionals doing what doctors do and
talking about things doctors talk about.Role models are everywhere.
I might add my classmates and I made that transition with the "benefit" of the trophies- for- everyone -before- the- game white coat ceremony.
Dr. Smith said, once the transformation occurs you cannot think of
being a physician as just a job.And it is difficult to think of yourself
as any thing but a physician.
And because of that transformation
it becomes very hard for a physician to retire or to be forced to leave
practice because of illness. Are you transformed back into a lay person
or are you still a physician who ...?