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Towards a New Definition of Medical Professionalism–Lessons to Learn From Hurricane Sandy

storm over American

Only one week ago, save for Turner Classic Movies, it was hard to find a radio, TV or internet outlet talk about anything except the upcoming presidential election.  How quickly things change.  Now we are watching floods, fires, devastated homes and a forever changed landscape on the eastern seaboard.  Not what anyone expected.

And like Sandy (interestingly neither male nor female in name), the unexpected is what we physicians deliver to our patients and their families everyday.  A child who is diagnosed with Rett’s syndrome who will slowly lose her chatty, interactive self to a bleak future for her and her parents.  A 45 year old woman, now faced with bilateral mastectomy as her “definitive” treatment, just two months after a normal mammogram, asking “why me?”.  The daughter whose mother no longer recognizes her and must decide if a feeding tube should be placed lest she die drowning in her own secretions.

With each of these scenarios, physicians have to dig deeply and use many of the “values” of professionalism. One of the best lists comes from an article written by Lynne Kirk, MD.  Included are: “commitment to professional competence, honesty, confidentiality, maintaining appropriate relations with patients, improving quality of care, improving access to care, just distribution of finite resources, acquisition of scientific knowledge and maintaining trust through avoiding conflicts of interest.”  All good.  But not good enough.

So what’s missing?  A personal involvement in that one person’s deeply human tragedy that occurs whenever something unexpected disrupts their lives.  Sure it happens to almost everyone at one time.  And now with Sandy, we are seeing so vividly, how it can happen to millions.  We all can share with the hurricane victims a feeling of sorrow and loss.  We can each care for and care about their well being, and mobilize to help.

That is what is missing from the present definition of professionalism as it pertains to physicians.  We can care for, but we are cautioned not to care too much about our patients on a personal level.  We must “maintain appropriate relations”–don’t cry with, pray with, feel sorry for, or reach out to our patients beyond our medical skills.

I think this is a limited and limiting definition of professionalism.  And I would bet many women physicians would agree.  It’s not that women have a corner on caring and empathy, but our upbringing, starting in early childhood, caring for and about others, is heavily rewarded.  It is embedded into who we are.  And not being taught in medical school that we can channel this most precious gift into our work, is part of the incredible tension under which women physicians practice.   We are judged and mis-judged either by our lack of empathy or by our over emphasis on caring rather than care.

It’s time to take another look at the patient-physician “professional” relationship.  It’s time to question a “truism” that our emotions will get in the way of giving good patient care.  It’s time for the unexpected–for women to be themselves and inject their natural propensity to create personal bonds with patients while maintaining the other elements of medical professionalism.  Will we need a small storm or a major hurricane to take on such a question?

One Note

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