Perspectives | 5 February 2002Medical Professionalism in the New Millennium: A Physician Charter Project of the ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine*[+] Article and Author InformationAnn Intern Med. 5 February 2002;136(3):243-246
Cruess SR, Johnston S, Cruess RL. Professionalsim for Medicine: Opportunities and Obligations.Iowa Orthop J. 2004; 24: 9–15.
Academics’ view on necessary skills and traits of a medical professional http://www.afmc.ca/pages/professionalism/1CruessSlides.ppt Accessed July 2007.
Deﬁning medical professionalism: a qualitative study Peggy Wagner, Julia Hendrich, Ginger Moseley & Valera HudsonMEDICAL EDUCATION 2007; 41: 288–2948 focus group sessions conducted between October 2002 and August 200351 subjects involved: 2 groups of faculty (1 family medicine, 1 paediatrics), n=112 groups of residents (1 family medicine, 1 paediatrics), n = 132 groups medical students, n = 162 groups of family medicine patients, n = 11Patient relationships main concern of patient group
Patients spent more time discussing the Patient Relationships theme than any other.
Importance of patient relationship noted by Sir William Osler
Expectations and Obligations - professionalism and medicine’s social contract with society, Richard L. Cruess and Sylvia R. CruessPerspectives in Biology and Medicine, volume 51, number 4 (autumn 2008):579–98
Clin Med. 2005 Nov-Dec;5(6 Suppl 1):S5-40.Doctors in society. Medical professionalism in a changing world. Working Party of the Royal College of Physicians
Cancer physicians' attitude towards treatment of the elderly cancer patient in a developed Asian countryBMC Geriatrics 2013, 13:35 doi:10.1186/1471-2318-13-35Angela Pang (firstname.lastname@example.org)ShirlynnHo (email@example.com)Soo-Chin Lee (firstname.lastname@example.org)Abstract Background With an aging population and an increasing number of elderly patients with cancer, it is essential for us to understand how cancer physicians approach the management and treatment of elderly cancer patients as well as their methods of cancer diagnosis disclosure to older versus younger patients in Singapore, where routine geriatric oncology service is not available. Methods 57 cancer physicians who are currently practicing in Singapore participated in a written questionnaire survey on attitudes towards management of the elderly cancer patient, which included 2 hypothetical clinical scenarios on treatment choices for a fit elderly patient versus that for a younger patient. Results The participants comprised of 68% medical oncologists, 18% radiation oncologists, and 14% haematologists. Most physicians (53%) listed performance status (PS) as the top single factor affecting their treatment decision, followed by cancer type (23%) and patient’s decision (11%). The top 5 factors were PS (95%), co-morbidities (75%), cancer stage (75%), cancer type (75%), patient’s decision (53%), and age (51%). 72% of physicians were less likely to treat a fit but older patient aggressively; 53% and 79% opted for less intensive treatments for older patients in two clinical scenarios of lymphoma and early breast cancer, respectively. 37% of physicians acknowledged that elderly cancer patients were generally under-treated. Only 9% of physicians chose to disclose cancer diagnosis directly to the older patient compared to 61% of physicians to a younger patient, citing family preference as the main reason. Most participants (61%) have never engaged a geriatrician’s help in treatment decisions, although the majority (90%) would welcome the introduction of a geriatric oncology programme. ConclusionsAdvanced patient age has a significant impact on the cancer physician’s treatment decision making process in Singapore. Many physicians still accede to family members’ request and practice non-disclosure of cancer diagnosis to geriatric patients, which may pose as a hurdle to making an informed decision regarding management for the geriatric cancer patients. Having a formal geriatric oncology programme in Singapore could potentially help to optimize the management of geriatric oncology patients.
Look neat and tidy – sloppy clothing does not give a patient much faith in your ability, especially if a surgeonDo as you would have others do unto you
Medicine is a unique professionPossible to face ethical/professional issues on a daily basisLearn from experienceKeep patient’s best interest at centreIf in doubt ask for guidance from seniors.
Medical professionalism workshop 11 may 2013
What is Medical Professionalism?
Medicine’s contract with society
Ann Intern Med. 5 February 2002;136(3):243-246
Medical Professionalism Through the Centuries
The Oath of Maimonides
First printed in 1793
“The physician fills two roles in
society: healer and professional.”
Cruess SR, Johnston S, Cruess RL.
Professionalsim for Medicine: Opportunities and
Obligations. Iowa Orthop J. 2004; 24: 9–15.
What does medical professionalism
mean to medical students, residents,
academic faculty and patients?
All have three primary concerns:
MEDICAL EDUCATION 2007; 41: 288–294
FACULTY RESIDENTS STUDENTS PATIENTS
Value of life
Be available 24/7 Tone of voice &
Dealing with stress Peer-based duty Need for superior
Help patients make
Power of resiliency Beyond normal
Maturity Takes effort to
“See me, hear me,
feel with me & be
fair to us”
Trust & spiritual
Have time for
Unique elements from the different focus groups
―Care more for the individual patient than for
the special features of the disease. . . . Put
yourself in his place . . . The kindly word, the
cheerful greeting, the sympathetic look —
these the patient understands.‖
Sir William Osler
British (Canadian born)
Physician & Mentor
involves expectations and
obligations on both the
physician and society
Drs. Richard and Sylvia Cruess of McGill University
leaders in Medical Professionalism
Expectations: The Public & The Medical Profession
Patient’s/public’s expectation’s of doctors Medicine’s expectations of patients/public
Fulfill role of healer Trust sufficient to meet patient’s needs
Assured competence of physicians Autonomy sufficient to exercise judgment
Timely access to competent care Role in public policy in health
Altruistic service Shared responsibility for health
Morality, integrity, honesty Balanced lifestyle
Trustworthiness (codes of ethics) Rewards: nonfinancial (respect,status),
Respect for patient autonomy
Source of objective advice
Promotion of the public good
Perspectives in Biology and Medicine, volume
51, number 4 (autumn 2008): 579–98
We define medical professionalism as a set of
values, behaviours, and relationships that
underpin the trustthe public has in doctors
Working Party of the Royal College of Physicians
Clin Med. 2005 Nov-Dec;5(6 Suppl 1):S5-40.
Trust breaks down when expectations
are not met
Doctor lacks trust in patient when patient
doesn’t mention past medical history (especially if
Patient lacks trust in doctor when the patient
perceives a lack of professionalism
“Doctor is a pervert.
He kept staring at
“Dr XXX is an impatient
person who talks very
loudly and is rude to me.
He doesn’t understand
the needs of the
Dr very tactless…he
should evaluate his
calling to serve patients.
If this is not his vocation,
I suggest he go change
his trade. Apparently he
has no love in doing
what he is called to do.
Application of SMC Ethical
Code in daily practice
Be dedicated to providing competent,
compassionate and appropriate medical
care to patients.
What do you do if you don’t know how to treat a
How do you remain compassionate when your last
patient turns up 30 minutes late for his appointment?
Be an advocate for patients’ care and well
being and endeavour to ensure that patients
suffer no harm.
Do you turn off life support in a brain-dead patient if the
Euthanasia & Physician-assisted death overseas and in
Provide access to and treat patients without prejudice
of race, religion, creed, social standing, disability or
A doctor shall also be prepared to treat patients on an
emergency or humanitarian basis when circumstances
How do you give low income patients the best
treatment when they can’t afford it?
What level of care do you give a foreign worker when
they need emergency care but cannot pay?
Would you offer an active 71 year old aggressive
treatment for breast cancer?
Abide by all laws and regulations
governing medical practice and abide
by the code of ethics of the profession.
What do you do if you face an ethical
issue you don’t know how to handle?
Maintain the highest standards of moral
integrity and intellectual honesty.
How do you balance the needs of the patient
with the commercial needs of private
A pharmaceutical companies wants to
sponsor your research on their drugs –
would you accept it?
Treat patients with honesty, dignity, respect
and consideration, upholding their right to be
adequately informed and their right to self
Would you tell an alert elderly patient their
diagnosis if their family asked you not to?
Your patient has terminal cancer and says
she doesn’t want any treatment to prolong
her life for another six months. What do you
Maintain a professional relationship with
patients and their relatives and not abuse this
relationship through inappropriate personal
relationships or for personal gain.
What would you do if there was mutual
attraction between yourself and your
patient (providing you were both single)?
What if a patient left you a significant
amount of money in his will?
Keep confidential all medical
information about patients.
Your 70 year old expat (UK) patient is married to
a 50 year old Singaporean. The patient has been
diagnosed with stage IV cancer – who do you tell
the diagnosis to first?
Your 55 year old male patient has been
diagnosed HIV+ and won’t tell his wife. What do
“You need to look and behave like a doctor looks
and behaves, and just imagine what you would
like a doctor to look like if you were going to be
seeing them yourself.”
Professor Jane Dacre
Vice-Dean and Head of Education at UCL Medical
School, London & GMC Council Member
“The practice of medicine is an
art, not a trade; a calling, not a
business; a calling in which your
heart will be exercised equally
with your head.”
Sir William Osler
British (Canadian born) Physician & Mentor