The Meaning of Professionalism
A professional is a collegial discipline that regulates itself by means of mandatory, systematic training. It has a base in a body of technical and specialized knowledge that it both teaches and advances it sets and enforces its own standards and it has a service rather than a profit orientation, enshrined in a code of ethics. To put it more succinctly, a professional has cognitive, collegial, and moral attributes. These qualities are well expressed in the familiar sentence from the Hippocratic oath, "I will practice my art with purity and holiness and for the benefit of the sick."'
The escalating commercialization and secularization of medicine have evoked in many healthcare professionals a passionate desire to reconnect with the core values, practices, and behaviors that they see as exemplifying the very best of what healthcare is about. This tension between commercialism, on one hand, and humanism and altruism, on the other, is a central part of the professionalism challenge we face today. As the journalist Loretta McLaughlin once wrote, "The rush to transform patients into units on an assembly line demeans medicine as a caring as well as curative field, demeans the respect due every patient and ultimately demeans illness itself as a significant human condition."
Historically, the legitimacy of healthcare is based on three distinct claims first, that the knowledge and competence of the professional have been validated by a community of peers second, that this knowledge has a scientific basis and third, that the professional's judgment and advice are oriented toward a set of values. These aspects of legitimacy correspond to the collegial, cognitive, and moral attributes that define a professional.
Competence and expertise are certainly the basis of patient care, but other characteristics of a professional are equally important. Being a professional implies a commitment to excellence and integrity in all undertakings. It places the responsibility to serve (care for) others above self-interest and reward. Accordingly, we, as healthcare professionals, must act as role models by exemplifying this commitment and responsibility, so that peers and students are exposed to and learn the kinds of behaviors that constitute professionalism.
The healthcare field is not infrequently referred to as a vocation. For most people, this word merely refers to what one does for a living indeed, its common definition implies income-generating activity. Literally, however, the word vocation means "calling," and the application of this definition to the healthcare profession yields a more profound meaning. According to Webster's Third New International Dictionary, a professional may be defined as a calling requiring specialized knowledge and often long academic preparation, including instruction in skills and methods as well as in the scientific, historical, or scholarly principles underlying such skills and methods, maintaining by force of organization or concerted opinion high standards of achievement and conduct, and committing its members to continued study and to a kind of work which has for its prime purpose the rendering of a public service.
Most of us went into the healthcare field because we wanted to help and care for people who are ill. To quote William Osler, "You are in this profession as a calling, not as a business as a calling which extracts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow man. We must work in the missionary spirit with a breath of charity that raises you far above the petty jealousies of life." We must explicitly incorporate into the meaning of professionalism those non-technical practices, habits, and attributes that exemplify the compassionate, caring, and competent physician. We must remind ourselves that a true professional places service to the patient above self-interest and above reward.
Professionalism is the basis of our contract with society. To maintain our professionalism, and thus to preserve the contract with society, it is essential to reestablish the patient relationship as the foundation of patient care.