Wednesday, 30 June 2010

Faith in Health Conference 2010: what makes a medical professional?

Though the question of what constitutes medical professionalism was not prominent in the titles of the sessions, it did nevertheless arise in more than one of the plenary lectures. The quality of the contributions on this point was, in my view, disappointing; but I should perhaps qualify that by recognising that those speakers who did touch on the question were not addressing it directly or fully.

Introducing one of the plenary lectures, Baroness Cumberlege referred to the report of a working party that she had chaired for the Royal College of Physicians in 2005, a report entitled Doctors in society: Medical professionalism in a changing world. The report can be downloaded in .pdf format from the website of the Royal College. Baroness Cumberlege cited its definition of medical professionalism, from chapter 5 of the report:
Medical professionalism signifies a set of values, behaviours, and relationships that underpins the trust the public has in doctors.
In itself, this didn't sound very useful (my notes taken at the time used the word "poor") because it does not define the "values, behaviours and relationships"; but it does need to be read with the description that follows immediately in the RCOP report:
Medicine is a vocation in which a doctor’s knowledge, clinical skills, and judgement are put in the service of protecting and restoring human well-being. This purpose is realised through a partnership between patient and doctor, one based on mutual respect, individual responsibility, and appropriate accountability.

In their day-to-day practice, doctors are committed to:

• integrity
• compassion
• altruism
• continuous improvement
• excellence
• working in partnership with members of the wider healthcare team.

These values, which underpin the science and practice of medicine, form the basis for a moral contract between the medical profession and society. Each party has a duty to work to strengthen the system of healthcare on which our collective human dignity depends.
In the same session of the conference, Sr Margaret Atkins talked about how Catholic health practitioners might preserve the sense of purpose which they had on entering the medical profession in a working environment that pressures them to move away from that purpose towards purposes driven by their employers or by government policy. Though not offering it as a definition of what medical professionalism is, Sister identified the healing vocation as having three elements: the making better of people who are sick (cure or healing), the provision of care and comfort, and the preventing of illness or keeping of health. The medical professional has responsibility for the patient in terms of their health, that is, in terms of these three elements.

At the beginning of her talk, Sr Margaret indicated that what she was going to talk about was, firstly, how those present as health care workers could keep their sense of purpose and secondly, and in my view quite significantly, how they might pass on that sense of purpose to others following them into the medical profession. This idea of "passing on" indicates that there is something that is permanent and unchanging in the idea of what it means to be a medical professional, and that that something is determinative of the nature of the profession. The implication of the RCOP working party report is quite the opposite. It suggests that the defining of medical professionalism needs to be responsive instead to the wishes of society around us.

I was a little disappointed that, in the discussion on professionalism in medicine, no reference was made to Luke Gormally's chapter "Medicine as a profession and the meaning of health as its goal" in the Linacre Centre publication Issues for a Catholic Bioethic. In that chapter, Luke Gormally is very critical of the World Health Organisation definition of health in terms of human well-being, the term that is adopted by the RCOP report. He argues instead that it is somatic health - the well-ordered organic functioning of the body - that is the proper goal of medicine as a profession. The purpose of the medical professional is then the restoration and maintenance of health defined in this way. It is this purpose that is the basis of the relationship of trust between the health professional and the patient. The professional is dedicated to the restoration and maintenance of health, and will not act in a way opposed to this, even if asked to do so by a patient; and the patient is deserving of courteous and just conduct from the professional out of respect for his dignity as a human being. The language of partnership and mutual respect in the RCOP description allows for something completely different.


Francis said...

Joe,you wrote:

I was a little disappointed that, in the discussion on professionalism in medicine, no reference was made to Luke Gormally's chapter "Medicine as a profession and the meaning of health as its goal" in the Linacre Centre publication Issues for a Catholic Bioethic.

Possibly because only you, the author and the editor has ever read it!!

Joe said...

I know I read some obscure things .... But this book isn't that obscure!