It is said that being a member of a profession involves a partly unwritten contract with society. In exchange for controlling or discovering the use of complex specialist knowledge and retaining the privilege of self regulation, the profession guarantees its members will be competent, altruistic and act with integrity. [1]

Physicians operate with dual roles of healer and professional informed by scientific knowledge and guided by ethical standards of behaviour. Their ethics are based on humanist and spiritual value systems.

A code of conduct for doctors that represents the core of professionalism has been described [2]. This includes such attributes as honesty, morality, tolerance, trust, humility and compassion, with a commitment to self directed learning. Traits to be avoided include arrogance, dogmatism and nihilism. A paternalistic approach has also latterly been discouraged.

Challenges to Professionalism
The support of society for the professional control of medicine may have declined as the public have become better informed and willing to challenge what has been seen as failures of self regulation, and collegiality to protect less than fully competent practitioners.

Other challenges to the professional status of medicine have come from loss of autonomy, greater political and managerial control of the NHS, target setting, and reduced input into policy making. Cost control and financial targets have eroded clinical freedom.

Reassessing Professional Values
The way ahead is to continue to emphasise the positive aspects of professionalism, while helping the public to maintain trust in the actions of doctors. The key to this will be guaranteeing that members are competent, and standards will be maintained through processes of recertification and revalidation. Regulation of the profession will have to be planned with representatives of the public and incompetent practitioners dealt with fairly and openly.

The values of ethical conduct and altruism need to be taught to medical students and doctors in training, in order to restore value based practice currently eroded by threats to continuity of care through changes in patterns of work.

Accountability is a key attribute of the practising physician, but in future individual clinical responsibility may be replaced by multi- professional team based accountability. The design of the ‘system of care’ is paramount. If Health Services continue to be designed on utilitarian principals, the desire of the physician to do their best for the individual patient may need to be enhanced by a philosophy of acting for the common good of society in order to re-establish influence over policy and expenditure.

The medical profession of the future will not only need to discover, update and control complex specialist knowledge and practice, but also take responsibility for sharing the knowledge base with other health professionals. This encourages commonality and consistency in approach and reduces professional rivalries.

Extant values that the profession of medicine should respect and promote include greater respect for elders, acceptance of alternative lifestyles, better work-life balance, and intolerance of discrimination on the basis of age, race, gender and ethnicity. Adjusting work practices to ensure services are patient centred, easily accessed and convenient will be important in the future.

References

1. Cruess S.R.; Johnston S.; Cruess R.L. Professionalism for Medicine: Opportunities and Obligations. MJA 2002, 177 (4) 208-211

2. Duff P. Professionalism in Medicine: an A-Z primer. Obstet Gynaecol. 2002: 99: (6) 1127-8