By Jacqueline Gierer, OMS-IV
What does professionalism mean to you? Is it the oath to put patients first, and your personal priorities second? Is it actually rising from your warm bed, getting dressed, and showing up to NYCOM for class? What about vowing to not identify who you bumped into in HIV clinic today while three ‘mind-erasers’ deep at the Peddler?
Professionalism is a prevailing theme in the medical community. A quick Google search will reveal a plethora of articles on topics including medical ethics, business models, health insurance, pharmaceutical trials, and the very essence of doctoring. In fact, the American Board of Internal Medicine Foundation recently awarded the first-ever Professionalism Article prize to three scholarly articles published in the esteemed New England Journal of Medicine and the Journal of the American Medical Association.
One of these articles, entitled Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues, by Catherine M. DesRoches, et. al discusses the results of a nationwide survey on physicians’ opinions and actions when dealing with a colleague who has shown to be (potentially) harmful to patients through incompetence or impairment. An interesting dichotomy was revealed in the physicians’ responses to a standardized panel of questions that, while most physicians agree with the commitment of reporting such offenders to the appropriate authority, only 67% had actually done so.
This raises an interesting and persistent conundrum that student and practicing physicians alike often face. Patients hold their physicians to a high standard of excellence, and often the physicians place even more pressure on themselves to achieve this level. Still, physicians (and medical students) are real people: people with emotions, people who make mistakes, people who have weaknesses, and people that like to have fun.
In order to examine your own personal judgment, I propose a case:
‘You are a third year student on your surgery rotation. Your best friend is going through a really tough time. His fiance just broke off their engagement and he just learned he failed the Pediatrics Shelf Exam, requiring him to remediate at the end of the year. Knowing full well that you both are expected to scrub into the first case of the day tomorrow morning, a breast lumpectomy and axillary node dissection, you offer to take him out for drinks. It’s not like you do much during the cases anyway. As you both are engulfed in conversation, one drink turns into six. You look over and realize it is 2:00am, and you are to be in the O.R. by 6:00am; however, you can see the burden lifting from his shoulders, the turmoil disappearing from his face as he drinks and talks and drinks and talks. Finally, at 3:15am, you both stumble home and pass out. The next morning, on less than three hours sleep, you show up to your case. Your attending informs you that the resident assigned to the case is sick, and your buddy will be scrubbing in as first-assist. A veil of fatigue engulfs your friend’s face but being a diligent medical student, he obliges with enthusiasm. The first incisions are made and the attending begins to explain to your friend the absolutely imperative need for focus and stillness during the dissection in order to avoid severing any crucial nerves. As he talks, you see your friend nodding off under the hot lights, his grip on the retractor weakening…”
What do you do?
It is easy to assume you would speak up. Do no harm, right? On the other hand, your friend has his hands full with problems, and speaking up could destroy his reputation with the attending, hospital, and medical school. Plus, for all you know, he could be just fine and you would be risking a severed friendship by getting him into unnecessary trouble.
As physicians, we are subject to a myriad of trying professional situations. Obviously, as reflected by the study, there is a stark contrast between physicians’ aspirations and their behavior. One way to prepare ourselves for such challenges is to consider possible scenarios before they arise, and discuss the options with our colleagues and friends. Therefore, when you find yourself in a tricky situation, you can rely on your planning and forethought to guide you as you proceed.
You may find the full article in JAMA here, accessible through your NYCOM Library subscription: http://jama.ama-assn.org/content/304/2/187.short