Symposium 9 - Medical Professionalism

Most doctors provide a high standard of care to their patients. In addition to expertise in their specialty, they must also demonstrate important generic professional capabilities which are essential to providing safe and effective patient care. These broader human qualities – such as being able to communicate effectively, to work as part of or lead a team, to teach or educate and to apply a range of other professional skills or judgements in complex or difficult circumstances – are in combination the foundation of professional practice. In the UK, the General Medical Council working jointly with the Academy of Medical Royal Colleges has been helping medical royal colleges and faculties embed generic professional capabilities into all postgraduate medical curricula from 2017 onwards.
United Kingdom General Medical Council data over many years show that most doctors who get into trouble do not do so because of a lack of medical knowledge or technical competence. Most commonly it is because of a failure of professional skills – poor team working or communication, unprofessional behaviour or lack of insight into personal difficulties.
Good doctors make the care of their patients their first concern: they are competent, keep their knowledge and skills up to date but also establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law. Good doctors work in partnership with patients and respect their rights to privacy and dignity. They treat each patient as an individual. They do their best to make sure all patients receive good care and treatment that will support them to live as well as possible, whatever their illness or disability.
I will explore these concepts and there will be an opportunity for questions.
 

Medical professionalism is the belief system that formulates and upholds the values and standards of medical practice. It underpins our social contract with society that allows us to self-regulate and maintain autonomy. Changing expectations from patients and doctors as well as the introduction of disruptive technologies such as genomics and genetics, robotic surgery and big data analytics prompt us to re-think how medical professionalism should be articulated and inculcated in the contemporary era. 
The recent establishment of the Professionalism and Ethics Committee by the Hong Kong Academy of Medicine (HKAM) is a response to the challenges. This Committee is tasked to:
(1) promote medical professionalism and ethical practice among Academy Fellows through education, training and advocacy;
(2) review and advise on the provision of specialty-specific training in medical ethics and professionalism by Academy Colleges;
(3) respond to requests by the Academy Council, the Education Committee and others as appropriate, and collaborates with relevant external organizations when necessary, on ethical issues related to the practice of specialty medicine and dentistry, public policy and other Academy matters;
(4) identify, examine and bring forward issues of ethical importance deserving the attention of the Academy Council, its constituent Colleges or committees;
This paper examines the opportunities for and challenges against these endeavors.
 

Risk, in regulatory terms, is usually considered in terms of risk to patients, but students and practitioners may, themselves be at risk  of harm or self-harm in environments where they are unsupported or subject to unreasonable demands.

Students and doctors are at risk of poor performance because of:

- lack of knowledge and skill (training and CPD)

- inability to apply knowledge and skill (personal and external factors)

- impairment (mental or physical illness, substance abuse, age related conditions)

- lack of professionalism (personality and circumstantial factors)

When a student or doctor demonstrates features of both impairment and poor performance, it is essential to deal with their health as the priority. They are unlikely to be responsive to remedial interventions if they are unwell or cognitively impaired.

It is a consistent findings across jurisdictions that poor performance is particularly associated with older age, male gender, previous complaints/poor prescribing, isolated practice, international graduates, high volume practice. Recognising these risk factors enables limited resources to be targeted where they are most effective. Clearly, it is desirable to identify potential performance issues early, when intervention (remediation or risk-modification) is easier and before harm, either to patients or the student/practitioner occurs. This often requires a partnership between the workplace and the regulator; the latter offering a range of graded interventions that reserve disciplinary action for a minority of cases.

This paper will explore:

- the identification of medical students and doctors at risk

- work-place interventions

- ‘right-touch’ regulatory interventions