Physician Professionalism: The Crucial Core Competency You Can't Teach

May 23, 2011

As a former full-time faculty member, I regularly had to rate residents in six core competencies ... I had often felt that the most crucial of them all, and the one that is the hardest, if not impossible, to teach is professionalism.

As a former full-time faculty member, I regularly had to rate residents in six core competencies - six general categories of skills or assets needed for one to be considered a competent physician, one who could safely care for patients independently. I had often felt that the most crucial of them all, and the one that is the hardest, if not impossible, to teach is professionalism. Without it, all the others are moot.

One can learn the pathophysiology of a disease (medical knowledge), know the appropriate tests to order and the gold standard of therapy (patient care), learn it through actual patient interaction (practice-based learning), utilize the rest of the health team (systems-based practice), and be able to explain it to the patient and the rest of the health team (interpersonal and communication skills), but if you cut corners, lie, steal, or cheat, it is all worthless, it eventually impairs patient care, and if there is any justice in the world, will lead to punishment of some sort. It can be the loss of trust by a patient, a malpractice suit, losing one’s license, or even jail.

It may seem innocuous, at least to the perpetrator. I’ve had patients tell me that they used to see a doctor that never touched them. He would come in, ask a few questions, and write a prescription. Yet, his notes indicated a full nine-organ physical exam. I have found foot ulcers on patients with “normal” foot exams, ulcers that obviously had been there for a while.

It can be covering up a medical mistake. Studies show that patients would rather be told up front that an error was made, and are much more likely to sue if they find out that they have been lied to.

And how often do we hear about doctors who re-use needles? Who dispose of medical waste improperly? And then there are the doctors who prescribe narcotics and other controlled substances for profit.

Often, but certainly not always, the same people who would behave unprofessionally are the ones who cut corners, lie, and cheat elsewhere in life. Maybe they lie to friends, spouses, and/or employees. Maybe they don’t pay their taxes. They ask a colleague to cover for them for a few hours, and then call later to say they can’t come back.

One may be a brilliant clinician, but without the respect of others, one is doomed to fail. A competent doctor with a solid reputation, who can communicate with his patients and who acknowledges his mistakes and limitations, will have happy patients who keep coming back and who will entrust the health of their family and friends to him.

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