Wednesday, December 12, 2012

Nostalgic Professionalism- Be Gone!

The concept of professionalism is changing in medicine, particularly in the era of duty hour restrictions. Here is a viewpoint on professionalism recently published in JAMA.
Marcus Welby, MD: Nostalgic Professional

The implementation of duty hour restrictions for physicians in training has raised the concern about a potential erosion in professionalism. Old school physicians (old school includes me and is defined by anyone who was trained prior to duty hour restrictions) cling on to the now 'antiquated' notion of 'nostalgic professionalism.' This form of professionalism is defined as consistently placing the patient's needs or the profession's needs above one's own personal needs. 

These values conflict with the current model of training. The newly proposed model of professionalism emphasizes the recognition of physician limits as humans, emphasizing the importance of physicians' health and alertness. I have certainly heard much about 'work-life balance' from residents and students at the university hospital where I work. When one is in training, there really is no substitute for direct patient care. Learning the practice and art of medicine requires long hours.

The solution? Per the authors, the new professionalism paradigm would be best served by a residency training system that fully adopted a team based model of patient care, one in which patient ownership was not delegated to a single resident/physician, but shared among a group of team members.

I am not necessarily opposed to the new paradigm of professionalism. However, I am not fully sold on the concept either. My concern is that, across a team, not all team members will really know the patient in full. I find it difficult to comprehend how a team will truly understand a patient, as an individual physician does through a history, a physical examination and careful reading of the patient's disease and personal narrative. That is how the doctor-patient relationship is built, enriched and sustained.

If we rely on the new paradigm of professionalism, one grounded in the 'team-patient' relationship, we may fall short of our goals of genuine patient ownership and responsibility. 

Those close to me know that I am not a conservative guy, but on this point, call me old fashioned.

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