This blog is a copy of an article written for GP Online. The full copy can be found here:
Are there times when the concept of professionalism can be dangerous? I think that unexamined approaches to professionalism can be harmful to ourselves and to our patients. We need to be looking at professionalism in context, and questioning whether the system we work in supports professionalism, or militates against it.
I clearly remember my sense of desperation when a practice manager reminded me that I’m a professional as I saw yet more home visits being added to the end of my already overloaded list, without me having any say in the matter. Professionalism can mean going the extra mile for patient care. But that concept of professionalism is only sustainable when there is some slack in the system, so that whilst at times you expend more, at other times you recuperate. With every minute in General Practice counting in an endless stream of intense activity, it can seem that our sense of professional duty is being systematically strained to breaking point.
I’m in good company. Last year the RCGP published ‘Patient safety implications of general practice workload’1, and questioned whether professionalism really means that we keep meeting the ever-increasing workload. Can we truly be empathic and clear-minded, delivering safe, high quality care when we are frazzled, with a rumbling stomach, and a full bladder?
A definition of professionalism from the Royal College of Physicians places trust at the centre of professionalism:
“Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors.” RCP, 20052
Patients should be able to trust they are in good hands, and that they will receive the very best care we can offer them. The RCP report describes how contemporary concepts of professionalism place more emphasis on the collective systems and cultures we co-create through leadership, team-work, education, appraisal and research. The practice of medicine is situated within a complex organisation, with financial and political pressures bearing down upon it. There are discrepancies in the apportioning of accountability for good healthcare, so that it remains easier to place the blame for poor care at the feet of an individual practitioner than it is to hold the entire structure of healthcare to account. All people shaping the healthcare system – from politicians, ministers, managers, commissioners to the public who use the service – need to embody a reciprocal duty to create the conditions in which healthcare professionals can best discharge their professional duties. There is an ethical duty to provide a context which does not damage the people working in it, but enables them to do their work well.
NHS England is renewing effort to create contexts in which we can work effectively, compassionately and professionally. Hopefully we can start building smarter, more sustainable work patterns. This will require us to further develop teams and alliances across different organisations. Collaborating effectively across the wider system in which we work will form an increasing component of our professional practice.
For our own well-being, we need to be mindful of the changing contexts in which we work, reflecting on whether our concept of professionalism needs adjusting to our current setting. Gone are the days of paternalistic, heroic professionalism in which the doctor could be relied on to respond to all woes day and night. Nowadays, the foundation stone of our professionalism is to ensure we are in a good state of mind and health ourselves, so that we are best able to engage fully with the patient before us, to communicate effectively, to make good decisions and to work well with colleagues. Professionalism can - at times - mean saying ‘no’ to more work when we are simply not up to it. It can also mean placing more emphasis on prevention, and on empowering patients to find their own resourcefulness in looking after their health.
© Contextualyse Ltd. 2016
1. RCGP (2015) Patient safety implications of general practice workload. London: Royal College of General Practitioners.
2. RCP (2005) Doctors in Society: Medical Professionalism in a Changing World. London: Royal College of Physicians