A Behavioral and Systems View of Professionalism - New JAMA Perspective Highlights the Role of Medical Education and Public Policy in Supporting Medical Professionalism

PHILADELPHIA, Dec. 22, 2010 /PRNewswire-USNewswire/ -- Physician behaviors are "profoundly influenced by the organizational and environmental context in which care is delivered," according to a perspective in this week's Journal of the American Medical Association authored by leaders of the American Board of Internal Medicine and the ABIM Foundation.

The perspective authors articulate a behavioral and systems view of professionalism where delivery system leaders and policy makers help shape medical professionalism.  The authors note that professionalism is behavior based and influenced by the environment in which physicians practice and therefore the education and regulatory environments play a key role in promoting professionalism.  

The article, A Behavioral and Systems View of Professionalism, developed out of the work of the American Board of Internal Medicine and ABIM Foundation Professionalism Task Force and highlights the fact that medical professionalism needs to evolve from being conceptualized as an innate character trait or virtue to sophisticated competencies that can and must be taught and refined over a lifetime of practice and that these competencies are influenced by health care systems.  In addition, "Professionalism is not simply a set of text-based ideals for practice, rather it is an approach to the practice of medicine that is expressed in observable behaviors" and professionalism can be taught, observed and assessed.

The values embodied in this articulation of professionalism include: compassion, integrity and accountability, a pursuit of excellence and fair and ethical stewardship of health care resources. The authors caution that physicians alone don't determine professional behavior, and may "feel bludgeoned by admonitions to 'be professional' in systems that foster and reward unprofessional behaviors."

The article builds on the ABIM Foundation's mission of advancing professionalism as defined in Medical Professionalism in the New Millennium: A Physician Charter.  The Physician Charter, authored in 2002 in partnership with the American College of Physicians Foundation and European Federation of Internal Medicine, has as its fundamental principles the primacy of patient welfare, patient autonomy and social justice.  The Charter also articulates professional commitments of physicians and health care professionals, including improving access to high quality health care, advocating for a just and cost-effective distribution of finite resources and maintaining trust by managing conflicts of interest.

The article was authored by current and former Board members and staff of the American Board of Internal Medicine and the ABIM Foundation:

• Cara S. Lesser, MPP, Director of Foundation Programs, ABIM Foundation (former); Deputy Director, Office of Planning and Evaluation, Office of Consumer Information and Insurance Oversight, U.S. Department of Health and Human Services (current);
• Catherine R. Lucey, MD, FACP, Vice Dean for Education, College of Medicine, The Ohio State University and Chair Elect of the American Board of Internal Medicine;
• Barry Egener, MD, Medical Director, The Foundation for Medical Excellence;
• Clarence H. Braddock III, MD, MPH, Associate Dean for Medical Education, Stanford University;
• Stuart L. Linas, MD, Professor of Medicine, Rocky Mountain Professor of Renal Research, University of Colorado-Denver School of Medicine; and
• Wendy Levinson, MD, Sir John and Lady Eaton Professor and Chair, Department of Medicine, University of Toronto.

According to the authors, "Professionalism may not be sufficient to drive the profound and far-reaching changes needed in the health care system, but without it, the health care enterprise is lost."  

The mission of the ABIM Foundation is to advance medical professionalism to improve the health care system. We achieve this by collaborating with physicians and physician leaders, medical trainees, health care delivery systems, payers, policy makers, consumer organizations and patients to foster a shared understanding of professionalism and how they can adopt the tenets of professionalism in practice. To learn more about the ABIM Foundation, visit www.abimfoundation.org, connect with us on Facebook or follow us on Twitter.

SOURCE ABIM Foundation