Six steps to effective medical professionalism in the 21st Century
Our Patron, Sir Donald Irvine CBE MD FRCGP FMedSci, is a longstanding advocate of person centred healthcare. Formerly President of the General Medical Council (GMC), he is currently a Vice-President of The Patients Association and Patron of Age UK Northumbria. His opinion on clinical accountability and care improvement processes in general are valued the world over.
His latest contribution is published in the second edition of the excellent book “Teaching Medical Professionalism: Supporting the Development of a Professional Identity.” This book presents ideas, evidence and guidance around how changing human behaviours can be used to support medical advancement and clinical education. In doing so, it has become a valuable learning resource for training physicians. Supporting them to be not only clinically competent in their roles, but caring, publicly responsible doctors whom patients can believe in and trust.
Sir Donald’s chapter, entitled; “Professionalism, professional identity and licensing,” reflects on what it means to be a clinical professional in modern-day society. Specifically, how digital advancements such as the information technology revolution have helped shape patient expectations. For those that haven’t yet read it, Sir Donald sums up the key points in securing effective medical professionalism for patients in the early 21st century:
The key messages are as follows.
Power to the patient
Today, medical paternalism is giving way to a more equal relationship between patient and doctor. It is the patient who has the illness and so it is the patient who is – or should be – the final arbiter of what is right for them. It is their body, their mind, their illness and their life. The doctor is there to help them and to give medical care in accordance with best clinical practice and the patients’ wishes.
What ‘good’ means for patients
For patients and their relatives, a good doctor is one whom they feel they can trust without having to think about it. Patients and their families equate “goodness” with clinical and ethical integrity, safety, up-to-date medical knowledge and diagnostic skill, sound judgment and an ability to form a good relationship with them. For them, good doctors are clinically expert yet know their limitations. They are honest, interested in their patients, listen to them, will be an advocate for them, are kind, courteous, considerate, empathetic, respectful, and caring. They are good team players when teamwork is needed.
These qualities form the basis of the principles of person centred care, which, when translated into every patient encounter, are the essence of modern medical professionalism.
Good patient care, always
A person’s health is the most valuable asset they will ever have. They will want to be sure that they always see a good doctor when they are ill. No sensible person would ever knowingly choose a bad doctor or even one whom they think is barely adequate.
The public’s defining expectation is therefore to expect a good standard of practice and care from any doctor in every consultation. Consistency in the quality of medical care is fundamental.
Maintaining licensure through revalidation
To support and reinforce that professionalism, we need equally modern professional regulation. British law now requires that all doctors must show that, currently, they are up to date and fit to practice. Their license to practice, given by the GMC, is now regularly updated through the process of revalidation.
The key to effective revalidation is in the assessment of the evidence. Both the evidence itself, and the current means of assessment, are not yet fully fit for purpose. Serious development still needs to be done by the profession, the GMC and employers to demonstrate a standard of current practice through licensure that will give the public real confidence.
Measuring patient experience
Demonstrating doctors’ ability and willingness to relate well to patients, and to communicate effectively with them, requires a robust methodology that exists but is not routinely used by the GMC or NHS employers. It needs to be.
Transparency is essential
To be effective, revalidation needs to be accompanied by a new order of transparency, and public accountability. I envisage a world in which patients and employers can look up doctors’ names on the GMC register. They would learn about doctors’ personal practice, what clinical results they are currently achieving, what their patients and colleagues think about their experience with them, and any other information that distinguishes them from others. Patients would then be able to use this information to choose a doctor with confidence. Employers would have valuable information that would help them support their doctors to maintain a good standard of practice, and to act promptly when there seem to be problems.
“Professionalism, professional identity, and licensing and accrediting bodies”, in Richard L. Cruess , Sylvia R. Cruess , Yvonne Steinert (eds), Teaching Medical Professionalism, 2nd Edition 9781107495241 is available to buy here