Medical Professionalism: Defining the Intangible


Dr. Malaya Santos

Dr. Malaya Pimentel-Santos is a long-time community health advocate, having worked with several nongovernment health organizations. She is a fellow of the Philippine Dermatological Society and a professor of microbiology at the St. Luke’s College of Medicine.

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Professionalism is a word we often encounter – and use – as health professionals, despite the fact that we may not all share a unified concept or definition. A quick online search will reveal that most dictionary definitions of professionalism are circular (i.e. they refer back to the term ‘professional’ in defining professionalism).

Last week, I was invited by a friend and colleague to give a series of talks on professionalism, as it relates to medical practice and research. To prepare for this, I searched across the medical literature and combed through various professional guidelines and standards. I also engaged in considerable inward reflection, in an attempt to define my own personal philosophical and professional paradigm.

Oath of service

The American Board of Medical Specialties defines medical professionalism as “a belief system about how best to organize and deliver health care, which calls on group members to jointly declare (‘profess’) what the public and individual patients can expect regarding shared competency standards and ethical values, and to implement trustworthy means to ensure that all medical professionals live up to these promises.” This links the concept of professionalism to what may very well be its origin or precursor: the act of ‘professing’, making a promise or taking an oath.

In the Philippines, the Professional Regulation Commission (PRC) carries out the critical task of defining, monitoring and evaluating standards and guidelines for competence and professional practice. I still vividly remember the day in 1996 when I took my oath as a physician and was granted a license to practice medicine.

In the original text of the 2,500 year-old Hippocratic oath, ancient healers had to swear by Apollo, his son Asclepius and other Greek gods and goddesses. While the oath has evolved through the centuries, its fundamental principles remain deeply relevant to this day. In 2017, the World Medical Association general assembly adopted a revised version of The Declaration of Geneva, The Physician’s Pledge, as follows: (add image).

Professional behavior, commitment to service

Practicing medicine – or any other profession, for that matter – is a privilege that comes not only with a certain measure of influence and authority, but also with a significant degree of obligation, commitment and accountability. Specific attitudes and behavioral attributes are conventionally associated with medical professionalism: being responsible and dependable in the performance of our duties; communicating with honesty, respect and propriety; and protecting patient privacy and confidentiality.

The professional and ethical standards outlined by the PRC and our respective professional societies are basically there as a reminder to always hold ourselves to the highest standards of excellence, competence and integrity; and to use our talents – to the greatest extent that we are able – to serve our individual patients and respond to the needs of our profession and the larger society we live in.

Dr. Charles Boelen is credited as the originator of the World Health Organization’s ‘five-star doctor’ model that calls upon physicians to aspire not only to be expert clinicians and care providers, but also excellent and competent decision-makers, communicators, community leaders and managers. For me, this means being cognizant of the social determinants of health and doing our part to contribute more broadly to society by helping the ones who need it most: those who are vulnerable and marginalized because of poverty, race, ethnicity, gender, disease, and any other form of social inequity.

Spiderman’s uncle Ben famously spoke of the responsibility that accompanies great power. A similar principle on the obligations of nobility (noblesse oblige) is attributed to Voltaire, and a related theme is also found in the bible in Luke 12:48: “For unto whomsoever much is given, of him shall be much required: and to whom men have committed much, of him they will ask the more.”

As we continue along the path of our individual professional journeys, unavoidably hampered by our own distinctly human frailties, we must nevertheless continually strive to uphold the highest professional standards of behavior. More importantly, the Hippocratic oath and other contemporary guidelines and charters should serve as a reminder of the greater guiding principles of ethics and professionalism: the shared commitment to serve our patients and humanity; and the collective pledge to help improve the quality of health care and contribute to scientific knowledge through research, education, and lifelong learning.

May 2018 Health and Lifestyle

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