Professionalism: Lifelong Commitment for Surgeons

[womansurg]

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Presently, there is a major intitiative to rekinkle the humanistic qualities in the practice of medicine. Although there have been many suggestions on ways to rejuvenate this initiative, it has not been a primary focus of graduate medical education until recently.

Surgery residents are expected to maintain a high standard of ethical behavior; demonstrate a commitment to continuity of patient care; and demonstrate sensitivity to the age, gender, and culture of patients and fellow heath care professionals. We in surgical education must accept the responsibilty fo the renewal in teaching and evaluating the professional and ethical principles of surgery residents. This change will not happen quckly, but it should be done skillfully because future generations will look back on this time of renewal in medicine and critique us on our ability or inability to achieve this goal.
Welling RE and Boberg JT. Archives of Surgery. 2003;138:262-4.

O yeah, baby. Let's keep it going!

 

[hotbovie]

Thanks for posting that, Womansurg.

I have to say that most of the surgeons I know do live up to those standards fairly well. They are generally very respectful of patients, and in our very trauma heavy program that can be difficult. (The perps get the same treatment as the victims). The residents are usually nice to the nursing and ancillary staff, and are well liked by most. And the surgery residents are more likely than any other group of residents to transport pts to various places (radiology, interventional, etc) personally. (Generally our ancillary services are good enough that residents aren't transporting). Our surgery residents are more likely than any other group to let students do procedures, and least likely to give students unnecessary scut. And I have seen staff get involved to make things happen, such as call the radiology department manager and ask that they call more techs in when we get too backed up.

Generally our surgery residents are a good bunch. As are staff. I have read a lot of very derogatory remarks about surgeons on these message boards. Hopefully those are either myths or isolated incidents.

 

[OwlMyste]

womansurg--i sent you a PM...check your Inbox, please...🙂

 

[edfig99]

I would not be able to care for many of my patients without my surgical colleagues, and for the most part, I have great relationships with my surgery resident counterparts (with very rare exceptions). I think there are numerous issues outside of our training programs that have led to the gradual decline in these "competencies" (man i hate that word) that now are leading to a hubbub. Most surgeons, heck, most doctors exhibit all of these behaviors, and it's not a matter of a "going back". It's all a result of the shift of paradigm from paternalistic (where docs STILL did all these things) to a patient-partnered style of care. It's the patient becoming a consumer and expecting good customer service.

Though I think the ACGME and the various RRCs demanding a "going back to the days of humanistic medicine, " they are going about things the wrong way by creating panic and extra requirements in residency.

AND not only do they want you to teach "humanity", they also want you to DOCUMENT that you're teaching this. As if there wasn't enough paperwork in medicine, lets add a little more.

man, i just wanna be a good doc and take care of people.

 

[vuillaume]

The thing about that abstract is that it seems entirely obvious that this is the sort of professionalism that we should all strive for. I guess the sad thing is that it evidently isn't so obvious, otherwise the authors would have had nothing to write about.

The NYTimes Magazine today includes a comment from an MD suggesting that physicians can play a role in reducing malpractice suits because patients that love their docs are disinclined to sue them even if a mistake is made...so we can add a shade of self-interest to professionalism too.

I'm not sure if the RRC can figure out, or ought to figure out a way to codify such training, but I think the shift in the culture of health care will take care of this to some extent. As edfig pointed out, medicine is now "consumer-oriented", so it's just good business and, more importantly, good medicine to develop a strong rapport with your patients.

Ironically, though technology over the last century has contributed to some of the impersonal and interventional-but-not-humanistic nature of modern medicine (as opposed to the 19th C. country doc who really couldn't do much other than suffuse his patients with humanism), I think technology is on its way to bringing it back. Though finishing-off the Human Genome Sequence's consequences for health care won't be seen immediately, it will eventually allow us to "individualize" prognosis and therapy. I think many patients feel a bit alienated nowadays, and this will bring them back (and perhaps reduce their need to dabble in herbal and homeopathic mumbo-jumbo).

As always: it was the worst of times and best of times...

 

[deleted4401]

Wow. All very thought provoking responses.

Here's a question: Do you think the recent cohorts of physicians, graduates of the last five-seven years, are more likely to contribute to the humanistic qualities of medicine?

The reason I agree with that is because it seems as though people have figured out that the hours are long, the money isn't as great as anyone thinks, and that it is mainstream knowledge that managed care makes practice sometimes harrowing.

I don't know - I just see the intangible qualities that drew many of us in the first place, like intellectual challenge, serving sick people, using science and technology to improve life, are superceding the other types of reasons: income, job stability, prestige. And this isn't necessarily good or bad, but sort of a regression from the 1970s and 1980s.

I feel that doctors that complain the most are the ones that graduated in the 1970s and 1980s. I feel that they think they were cheated out of the 'golden age' of medicine. What I don't think they realize is that the 'golden age' of medicine is always the present. And that's because we have more tools, knowledge, and technology than ever before. I don't think these burnout physicians are bad or wrong, but I think they misjudged what they were getting into.

It just seems that there has been another shift in the nature of the profesison. Like you all have said, this is becoming a patient-centered partership. Those unwilling to accept that role are seeing more options in more individualized, competitive, and performance-based jobs. And, I think it bodes well for medicine in general.

What do you think?

Simul

 

[DoctorDoom]

With the competitveness of medical schools and the huge increases in technological elements in our profession it was natural for schools to admit applicants who had good numbers in the "hard" sciences, reducing the total numbers of students who had more diversified educational and professional backgrounds. One of the things some schools are doing to increase the humanism in the physician pool is to take more non-traditional students and to look at students who are not the normal bio-major applicant out of college. The idea is that having a more diversified student body will help select for individuals who are already more aware of the humanistic side of medicine.

At my medical school a special program was in place to attract humanities majors (I was German Lit/ History double), poor students, and non-traditional students (one of my classmates was a Navy firefighter, several were working mothers). That was combined with classes and workshops in medical ethics, simulations and seminars on how to deal with patients of different cultures, overcoming language barriers, and a host of communications skills. Bedside manner 101, so to speak. Not only did it not detract from the regular curriculum, I think most of us found them really helpful and useful in working with diverse patient populations.

When I graduated there were signs of some of these programs being cut back because of financial concerns. That would be a shame as I think more schools need to teach these skills as well.

Good thought provoking thread, womansurg.

 

[DoctorDoom]

no one can teach you to be humanistic. i mean, in medschool yr 1/2 we took these classes on how to care and it irritated me so much. how the hell do you objectify and quantify the most subjective part of the entire field. it's like giving a lecture on brother's karamazov or clockwork orange. cliff notes, anyone?

Sure they can. It may be horribly abbreviated but the didactics can definitely help bring a broader perspective to anyone in the field. It's not a substitute for life experiences or a four year accredited program in philsophy but it does play it's role. Like Cliff Notes it should not replace reading Karamazov but rather be used as a study aid, so to speak.

The didactics make you at the very least aware and able to discuss certain medical ethical dilemmas, so that when you are REALLY busy next year and something comes up, at least you'll pause for a second and have at least an internal discussion about what to do next. Instead of getting into a fix and wondering "wait how come I didn't see it as a problem right from the start?"

And you're right, there is a lot more to it than simple trust and bedside manner. Sometimes it is a very valuable tool. The didactics teach extremely useful communicatons skills, which increase the amount of clinical information you get, especially when you are busy and need to be robotic. I would argue that once your communications skills with total strangers who are sick and feeling vulnerable, some of who you will cut open and some you already cut, improves, you'll not only need to be less robotic, but also enjoy just surgery and your patients more.

When I taught some of the classes in medical school as a 4th year, there were many students who felt as you do. You are caring people who feel like you need to get the job done. "Why is some one teaching me how to care, I know this stuff already." More often it was "what is all this touchy feely crap? I wanna scrub in on something." I started out that way actually. But I learned that my assumption that patients would know I cared through my clinical competence was not always true; patients often have no means of evaluating your skill. I also found I was woefully uninformed about the specifics of laws and current thinking on significant medical ethical issues. The didactics add more arrows to your quiver in the quest in becoming a better doctor. The thread is about professionalism, that's what the ultimate goal of these didactics are, to make you a better professional. Not to change your personality or to replace your clinical technical skills. In fact it is useful for me to think of my ability to overcome language barriers or my knowledge of other ethnicities as supplementary technical skills. It definitely comes in handy, especially as society becomes more distant.

And you are right, clinical competence is the priority. Good surgeons are humble. But not everyone realizes that, and not every surgeon is good. And you really can't teach humility in medical school. So the didactics give everyone a starting point, a bit of basic information to start you thinking. A bit of communication skills and simulations so that when you are shocked by an unfortunate event you have something to help your decision making process not as a person but as a doctor. It's a process of continual development. Which I think is necessary, especially considering the high pace of technical growth in our specialty. Technology and operative technique may chnage, but the human soul remains the same.

The old time surgeons always say it was better in the old days. They always stayed up for more hours and did more for their patients. They didn't have to worry about this because they considered themselves gods and could act as they pleased. Now we stay up late, we know things they have never learned (test your attendings' knowledge of molecular biology, you'd be surprised), and we can behave not as distant gods, but as respected and enlightened human beings. It's our future, and we can make it into a good one.