Medical professionalism workshop 11 may 2013


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  • 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 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 ( ( Lee ( 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

    1. 1. What is Medical Professionalism? Medicine’s contract with society Ann Intern Med. 5 February 2002;136(3):243-246
    2. 2. Medical Professionalism Through the Centuries Hippocratic Oath 5BC The Oath of Maimonides First printed in 1793 Physician’s Oath WHO, 1948 Physician’s Pledge SMC, 1995 Physician Charter* 2005
    3. 3. “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.
    4. 4. Source: Drs R & S Creuss
    5. 5. What does medical professionalism mean to medical students, residents, academic faculty and patients? All have three primary concerns: Clinical competence Patient Relationships Character virtues MEDICAL EDUCATION 2007; 41: 288–294
    6. 6. FACULTY RESIDENTS STUDENTS PATIENTS Knowledge & technical skill Decisiveness & being succinct Reciprocity of patient-doctor relationship Patient relationships Value of life experience Be available 24/7 Tone of voice & body language Dealing with stress Peer-based duty Need for superior colleagues to respect students Help patients make hard decisions Power of resiliency Beyond normal demands for compassion Caring, reassuring compassionate , approachable & give hope Empowerment vs authoritarianism Might hurt someone Maturity Takes effort to remain compassionate “See me, hear me, feel with me & be fair to us” Importance of other staff members Trust & spiritual angst Have time for patients Unique elements from the different focus groups
    7. 7. ―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 (1849-1919) British (Canadian born) Physician & Mentor
    8. 8. Medical professionalism involves expectations and obligations on both the physician and society Drs. Richard and Sylvia Cruess of McGill University leaders in Medical Professionalism
    9. 9. 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), financial Accountability/transparency 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
    10. 10. 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.
    11. 11. Trust breaks down when expectations are not met Doctor lacks trust in patient when patient doesn’t mention past medical history (especially if deliberate) Patient lacks trust in doctor when the patient perceives a lack of professionalism
    12. 12. “Doctor is a pervert. He kept staring at my boobs.” “Dr XXX is an impatient person who talks very loudly and is rude to me. He doesn’t understand the needs of the patient…” 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. Patient feedback KTPH
    13. 13. SMC Ethical Code & Ethical Guidelines
    14. 14. Application of SMC Ethical Code in daily practice
    15. 15. 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 patient? How do you remain compassionate when your last patient turns up 30 minutes late for his appointment?
    16. 16. 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 relatives refuse? Euthanasia & Physician-assisted death overseas and in Singapore
    17. 17. Provide access to and treat patients without prejudice of race, religion, creed, social standing, disability or financial status. A doctor shall also be prepared to treat patients on an emergency or humanitarian basis when circumstances permit.  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?
    18. 18. 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?
    19. 19. 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 practice?  A pharmaceutical companies wants to sponsor your research on their drugs – would you accept it?
    20. 20. Treat patients with honesty, dignity, respect and consideration, upholding their right to be adequately informed and their right to self determination.  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 do?
    21. 21. 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?
    22. 22. 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 do?
    23. 23. “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
    24. 24. “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 (1849-1919) British (Canadian born) Physician & Mentor