Thoughts on Professionalism

[cooldreams]

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Since Professionalism is becoming a growing theme in the schools, thought that maybe some might want to give some thoughts on this.

Good or Bad & why?

Me: just like in the military, if you start off from day one acting like a team, you will perform like a team when you are on your own. This seems to easily lend itself to professionalism in schools now where malpractice is growing, and respect is being lost, this seems like one of the viable routes that should be taken. I don’t really hear much of anything along the lines of this being a good thing on this website however. I currently work as an electrical engineer and wear business clothes to work everyday - yes this does mean a tie. I see that many of my colleagues at some other companies do not wear as professional attire as many at my company, and can see very clearly in prospective customers eyes that they think those of us dressed for the part are much more likely to perform the part. Thoughts?

 

[Kevbot]

Since Professionalism is becoming a growing theme in the schools, thought that maybe some might want to give some thoughts on this.

Good or Bad & why?

Me: just like in the military, if you start off from day one acting like a team, you will perform like a team when you are on your own. This seems to easily lend itself to professionalism in schools now where malpractice is growing, and respect is being lost, this seems like one of the viable routes that should be taken. I don’t really hear much of anything along the lines of this being a good thing on this website however. I currently work as an electrical engineer and wear business clothes to work everyday - yes this does mean a tie. I see that many of my colleagues at some other companies do not wear as professional attire as many at my company, and can see very clearly in prospective customers eyes that they think those of us dressed for the part are much more likely to perform the part. Thoughts?

I agree that doctors and medical students should always keep a sense of proffesionalism when dealing with patients and staff. I also believe as a future doctor, that having a sense of humor will allow me to keep my sanity. There are times for seriousness, and there are times to joke around. Knowing the difference will probably be a usefull skill in medicine.

Also, you seem to be concerned with malpractice. If you want a real look into what causes malpractice, you should read a book called "Complications" by Atul Gawande. Here's a good quote from it:
“Every doctor has things he or she ought to know but has yet to learn; capacities for judgment fail, a strength of character that can break.” - Atul Gawande

 

[raptor5]

I see that many of my colleagues at some other companies do not wear as professional attire as many at my company, and can see very clearly in prospective customers eyes that they think those of us dressed for the part are much more likely to perform the part. Thoughts?

Please excuse my grammar and spelling errors as I have to type fast b/c of an upcoming exam and my unprofessionalism
Back to the quote.
Seems like more of a business strategy than a way to seem professional. Who defines the 'part' that you eluded to? Professional behavior and dress is highly subjective. For example, here at PCOM we are supposed to dress profesionally for occasioinal mandatory events and practicals. Some interpret it as shirt and tie. You have those that wear a shirt, tie, and sneakers w/ khakis. Some where jeans, shirt and tie while others wear khakis, tie, dress but their whole appearance is disheveled and their clothes are wrinkled and dirty. Me, I prefer to not wear a tie. I normally wear a nice hugo boss dress shirt and dress pants that ironed as if it were a military inspection (ever since the military I am OCD about ironing). Now by the letter I am dress inappropriately and unprofessionally just b/c of my lack of a tie while the others are fine. These same people look at me in disgust b/c I say I do not need a tie to look prefessional. The way I view professionalism and what is consider professinal is different than others, we all have our own definition as to what fits the bill.
So out in practice some day in the distant future when I may own my own practice I will define what is professional as to what I think is appropriate for my patient population. Rural Texas will be much different than say Beverly Hills.

 

[LukeWhite]

Using "professionalism" as a synonym for "tie and dress pants" is like using "cool" to mean "nose ring and all-black attire." All depends on the crowd you're with.

I've never heard a particularly compelling description of the objective benefits of wearing a tie. On the other hand, I seem to recall that British researchers found out a few years ago that men who regularly wore neckties had decreased cerebral vascular flow and slight accompanying neurological symptoms.

For my part, I never step outside without my ascot.

"The wide circumference of an elaborate ruff beneath his gray beard, in the antiquated fashion of King James' reign, caused his head to look not a little like that of John the Baptist in a charger." --Nathaniel Hawthorne (The Scarlet Letter)

"Oh I have been to Ludlow fair, and left my necktie God knows where. And carried half way home, or near, pints and quarts of Ludlow beer. --AE Houseman

"I've found that you don't need to wear a necktie if you can hit." -Ted Williams

 

[DORoe]

I guess I don't understand why professionalism=shirt and tie? I can be a complete immature a$$hole and where a tie everyday. Does that make me professional? I agree that when interacting with patients it is important to "look like a doctor" I will happily where dress clothes when I am in clinic (Sometimes I actually prefer them to jeans and a t-shirt), but it makes no sense to me to make students dress in a shirt and tie to attend a class session or to study. I don't understand how someone going into class wearing their favorite pair of jeans and a t-shirt really shows a lack of professionalism. As for the rest of your post I am sorry I have no idea how dress has any influence on developing a team mentality. I don't look around a room and see if someone else is wearing a matching pair of shoes and immediately think, "Wow, we would work very well together!" I agree with your statement that developing a sense of teamwork and comraderie is very important, but I don't see how dress plays any role in this.

 

[cooldreams]

whoa guys, i didnt mean to hit on any touchy subject. i just thought that since many of the schools are more and more asking that students attend class in a more "professional style" that it might be interesting to talk about it. i had read a number of articles in ugrad that showed that student who were well groomed, and dressed in a nice and clean manner typically did better in class. as far as team work based on dress, that is pretty easy to look at a marching band or cheer leaders or even theatre where the dress you wear adds to the continuity of the team and allows a more structured and organized performance to follow through.

Luke, about the "crowd you are with to determine a subjective answer" i agree with you. however the "crowd we are with" are professional doctors. i suppose the answer to this would be to show that it is common place for well performing teams of doctors do not dress up at all. except even to that point, it is normally assumed that those of lesser learning and respect are held to a higher standard on these sorts of matters whereas those who hold a higher position are given much greater leeway... so i guess good luck with that arguement. i dunno man....

all i can really add is my personal experience, and that is nearly all of the doctors i have seen, and actually many even when they are not in a place of business will still dress up to some extent. and in my personal job, proper dress attire are just real nice plus marks in the eyes of potential customers - whether they are formally dressed up or not. that is just my personal experience over the last 3 years here in corporate kansas city. im not sure how you can argue around these social norms of conduct... i guess that is what i was hoping to talk about here... 😕

 

[LukeWhite]

Luke, about the "crowd you are with to determine a subjective answer" i agree with you. however the "crowd we are with" are professional doctors. i suppose the answer to this would be to show that it is common place for well performing teams of doctors do not dress up at all.

Many, many docs avoid professional attire. Some do it out of practicality: one's obviously going to have a bit more trouble in the OR if the cufflinks have to be fished out. There aren't many fields of medicine where a tie *wouldn't* get in the way, unless you decided to walk around all day with a white coat to keep it in check. Even a simple FP physical is made a bit tougher by a piece of cloth swinging around every time you bend forward.But plenty avoid the shirt-and-tie routine because they see it for what it is: a meaningless social custom.

You're absolutely right that those who haven't advanced as far in the ranks are more likely to dress up. Formal dress allows for the appearance of professionalism without the hassle of actual competence. Somewhere along the line, certain groups started mistaking the appearance for the thing itself.

Is it coincidence that the med schools most likely to have a dress code are osteopathic and perhaps at the lower end of most osteo school rankings? Obviously there are some very good schools with "always-on" dress codes, but these seem the exception. Our students won't be highly-regarded based on our long and prestigious history, the thinking must go, so let's dress 'em to the hilt to try for the same effect.

Insofar as formal dress calms and relaxes the patient, it's useful, though again I think that some docs just find tying a Windsor knot faster than establishing rapport and trust. But it's probably good to remember that it's only useful because it's satisfying a patient's irrational biases towards social custom; there's no inherent virtue to the thing itself. The administrators of certain schools seem to have forgotten this in their rush towards respectability.

 

[DORoe]

whoa guys, i didnt mean to hit on any touchy subject. i just thought that since many of the schools are more and more asking that students attend class in a more "professional style" that it might be interesting to talk about it. i had read a number of articles in ugrad that showed that student who were well groomed, and dressed in a nice and clean manner typically did better in class. as far as team work based on dress, that is pretty easy to look at a marching band or cheer leaders or even theatre where the dress you wear adds to the continuity of the team and allows a more structured and organized performance to follow through.

all i can really add is my personal experience, and that is nearly all of the doctors i have seen, and actually many even when they are not in a place of business will still dress up to some extent. and in my personal job, proper dress attire are just real nice plus marks in the eyes of potential customers - whether they are formally dressed up or not. that is just my personal experience over the last 3 years here in corporate kansas city. im not sure how you can argue around these social norms of conduct... i guess that is what i was hoping to talk about here... 😕

I still don't follow the logic with the comparison of being a physician to being a member of a team that is designed to be choreographed (sp?) such as a marching band or a cheerleading team. The two are seperate entities. I don't wish to practice medicine in the EXACT same manner as my classmates. I think that everyone brings their own style and approach to the clinical setting that reflect differences in personality. Whereas with marching bands and cheerleading squads the idea is to become completely one with the group. In these settings you don't want to notice a particular individual because it would distract from the larger picture. I really don't want to be regarded by my patients as just another one of the suits. I want them to know that I was the one that treated them based on the methods that I employ during our interactions. The theater example seems silly because clearly if you are performing Romeo and Juliet you will have to dress in appropriate attire. It would be odd to see Juliet wearing hip huggers and Romeo in a "wife-beater" tank top. I will agree with you however, when you say that one should be well groomed. I just don't think that good grooming habits need to be equated with dress clothes in the classroom learning environment. I have some clothes that are remnants of my ugrad days where I don't feel they are appropriate to wear any longer. My favorite "I rode the short bus to school" t-shirt is no longer in my wardrobe because I just don't feel that it is appropriate for my position. Perhaps I am being a little self-important, but I don't feel comfortable wearing it any longer. I can be a well-groomed person and still wear casual clothes when I am in class.

Regarding the second paragraph....I agree that when you are in clinic you should "look the part." Luke made a very good point about social conventions dictating the establishment of professional dress. It has been my experience that the method of dress by different doc's is dictated by the patients that they see. For example, I was in clinic with a rural family practice doc that dressed very casually. He wore jeans and a polo shirt most days. He instructed me to do the same after I showed up with my shirt and tie. When I asked him why his response was this, "These patients will feel more comfortable with you if you look less like their boss and more like a member of their community." His feeling was that looking more like them inspired a better trust. I'm not sure that I totally agree with his stance, but it seems to be a reasonable conclusion and he was not wanting for patients. On the other hand doc's that practice in the city seem to dress more traditionally. It's all a matter of what you percieve to be appropriate. I don't know that I would be comfortable in jeans in the clinic, but that is a personal thing.

 

[DocFrog]

Simply from a patient perception standpoint...as a female medical student, if I walk into clinic in casual clothing or scrubs (which happen to be my preferred attire) the patients tend to assume that I am the nurse and they ask me to send in the doctor. Yeah, its sounds kind of crappy, but you do what you gotta do to get respect, so drag out the dress pants and nice tops and dress it up! If the patients thinks of you as a responsible professional they are more likely to answer your questions truthfully and more likely to be complient across the board (and less likely to tell you preceptor what a nice new nurse he has hired... 🙄 )

 

[iatrosB]

This is very good discussion and an important topic. I think the discussion shows that there is not a formula for professionalism and it is possible to be unprofessional in dress clothes, and professional in casual clothes. It really comes down to HOW you practice. I know a rural doc who dresses Wall Street and his patients love him and I know an inner city doc who wears slacks and a polo and his patients love him. A really good book to read is Gesundheit! 👍 (the real Patch Adams story). It talks of professionalism, use of humor in healing, and malpractice issues stemming from a lack of the personal relationship between physician and patient.
As far as schools requiring students to dress professionally, whatever. I can parade around in fancy clothes for four years and then do my own thing when it is all said and done. Just another hoop to jump through in this circus we call medical education. 😀

 

[iatrosB]

Simply from a patient perception standpoint...as a female medical student, if I walk into clinic in casual clothing or scrubs (which happen to be my preferred attire) the patients tend to assume that I am the nurse and they ask me to send in the doctor. Yeah, its sounds kind of crappy, but you do what you gotta do to get respect, so drag out the dress pants and nice tops and dress it up! If the patients thinks of you as a responsible professional they are more likely to answer your questions truthfully and more likely to be complient across the board (and less likely to tell you preceptor what a nice new nurse he has hired... 🙄 )

Yeah, that sucks. At least society is changing it's perception of women as health care providers but it is taking it's time! With medical school admission statistics of >50% female classes, change will surely happen. Another factor that will force change is the increasing number of men as nurses. Good luck to you 👍

 

[stomper627]

Wasnt there a study out last year regarding colonization of ties? MRSA, I believe....interesting.
Anyway, as someone who attended a "professional dress" code school and as someone who has an 18.5 inch neck (bodybuilder), it sucks...I hate ties, but well worth it, as I had quite a large wardrobe once rotations started. Otherwise that first day of MSIII, Ida been hurtin either without much clothes, or financially as I would have had to do quite a bit of shopping!!!
stomper

 

[LukeWhite]

Wasnt there a study out last year regarding colonization of ties? MRSA, I believe....interesting.

http://www.cbsnews.com/stories/2004/05/25/health/main619496.shtml

But at least the professional look will make the malpractice suit less likely!

 

[DireWolf]

The notion that "dressing up" brings more respect to the profession is asinine.

I will wear scrubs throughout my career, no matter which specialty I choose. And luckily the issue of professional attire during medical school did not come up with the schools I applied to, because I would scratch any school off the list that requires professional attire and/or an attendance policy.

This is not kindergarten, it's medical school, with adults that are capable of making their own decisions.

 

[Runtita]

The notion that "dressing up" brings more respect to the profession is asinine.

Amen!

In my experience, patients are more likely to trust someone who doesn't act/dress "better" than them. And I do like to be comfortable, too. Life is too short and we have enough crap to put up with without having to wear suits.

 

[DireWolf]

Amen!

In my experience, patients are more likely to trust someone who doesn't act/dress "better" than them. And I do like to be comfortable, too. Life is too short and we have enough crap to put up with without having to wear suits.

*high-five*

 

[cooldreams]

Amen!

In my experience, patients are more likely to trust someone who doesn't act/dress "better" than them. And I do like to be comfortable, too. Life is too short and we have enough crap to put up with without having to wear suits.

pretty wierd... my experience has been completely the opposite. 😕

im not sure what to say about lukewhites comment about how just osteopathic schools are asking for more professional dress. it seems to me the "best" schools and private schools tend to expect this, if not mandate it of the students. am i really the only one who has seen/experienced this??

 

[DireWolf]

pretty wierd... my experience has been completely the opposite. 😕

im not sure what to say about lukewhites comment about how just osteopathic schools are asking for more professional dress. it seems to me the "best" schools and private schools tend to expect this, if not mandate it of the students. am i really the only one who has seen/experienced this??

well the two best schools, MSU and OSU, don't. so that blows your argument out of the water.

 

[LukeWhite]

cooldreams,

I think many private schools mandate it for just the reason I mentioned: their lack of a long and prestigious history leads to quick-fix attempts at prestige. Some school administrators enforcing the strictest dress codes also do things like, say, erect marble friezes of themselves (not to name names or anything). Same idea: try to get through superficial appearance what other schools have gotten by being around forty years longer.

Also, "private," when it comes to osteopathic schools, has a roughly opposite connotation from what it does in undergrad. Private schools are generally less well established and more prone to capricious and arbitrary regulations.

 

[cooldreams]

well the two best schools, MSU and OSU, don't. so that blows your argument out of the water.

"nuh uh, my school is the best so there"

 

[iatrosB]

cooldreams,

I think many private schools mandate it for just the reason I mentioned: their lack of a long and prestigious history leads to quick-fix attempts at prestige. Some school administrators enforcing the strictest dress codes also do things like, say, erect marble friezes of themselves (not to name names or anything). Same idea: try to get through superficial appearance what other schools have gotten by being around forty years longer.

Also, "private," when it comes to osteopathic schools, has a roughly opposite connotation from what it does in undergrad. Private schools are generally less well established and more prone to capricious and arbitrary regulations.

I think you and cooldreams are using different points of reference. You are using the new schools that are popping up everywhere and he is using KCUMB as his reference. KCUMB is very strict in the dress code and professionalism, but they have also been around for a long time (1916, fifth osteopathic school built) and have a great reputation. Some of the newer schools do not so that may be there reason for a dress code, but certainly not every private osteopathic school.

 

[Runtita]

pretty wierd... my experience has been completely the opposite. 😕

It may really depend on the patient population. I am referring to the average person. If you practice in the middle of a city with stockbrokers as your clients, though, YMMV.

 

[EMTLizzy]

Simply from a patient perception standpoint...as a female medical student, if I walk into clinic in casual clothing or scrubs (which happen to be my preferred attire) the patients tend to assume that I am the nurse and they ask me to send in the doctor.

It's a girl thing. We'll probably always deal with it, especially with older patients.

When I go to a hospital, I don't assume all the women walking around are nurses, but I know some of the older people just equate female with nurse and male with doctor.

I've found people take me more seriously when I'm wearing a suit, though. Maybe it's because for work I spend a lot of time in an office or in meetings. The "dressed up" look seems to command more respect.

Hospitals have dress codes for their employees anyway (and that includes the doctors), so we might as well get used to dress codes now.

 

[LukeWhite]

Hospitals have dress codes for their employees anyway (and that includes the doctors), so we might as well get used to dress codes now.

Hospital dress codes, though, are generally not "doctors-must-wear-dress-pants-and-tie." They tend to be a bare minimum rather than a high standard, so the argument that school dress codes help prepare us for professional realities doesn't really hold up.

The specialists I know who wear corduroy and open-collar shirts to work at their hospitals seem to have no trouble with patient respect. This, like the infamous long versus short coat, is a tempest in a teacup.

Nobody's going to look askance at a doctor who feels there's a benefit in dressing prettily, but problems start to arise when that doctor starts to feel self-important enough to impose those fashion preferences on everyone else.

 

[EMTLizzy]

Hospital dress codes, though, are generally not "doctors-must-wear-dress-pants-and-tie." They tend to be a bare minimum rather than a high standard, so the argument that school dress codes help prepare us for professional realities doesn't really hold up.

Hmm, well, my hospital system does.

[/QUOTE]The specialists I know who wear corduroy and open-collar shirts to work at their hospitals seem to have no trouble with patient respect. This, like the infamous long versus short coat, is a tempest in a teacup.
[/QUOTE]

On a side note, I hate white coats. I think they intimidate people. The whole White Coat Syndrome and such.


I'm just picturing a doctor walking into a patient's room wearing short shorts, a belly shirt, and belly button ring. "Paging Dr. Britney Spears."

I think we can all agree that as long as we're dressed appropriately, we'll be fine.

Might want to skip the flip flops in surgery, though.

 

[LukeWhite]

On a side note, I hate white coats. I think they intimidate people. The whole White Coat Syndrome and such.

And yet I know docs who insist on the white coat, stating with absolutely no sense of irony that it commands respect and trust by separating physicians from the patient.

Everyone has different philosophies, and I'm not going to begrudge the doctors their long coats. By the same token, it seems to me that we can trust people running codes to control their own dress codes.

On the one hand, we've got plenty of evidence that ties are filthy germ receptacles that decrease cerebral blood flow and possibly impair decision making. On the other, we've got the theory that patients will respect you more with a piece of cloth hanging from your neck. It seems to me a classic triumph of self-importance over practicality, but that seems a call each doc can make on his own.

 

[Kevbot]

I think its interesting that this thread started as a conversation about proffesionalism, using dress code as an example. And now it's become an arguement about the way a doctor or med student should dress.

Does proffesionalism = what you wear? I guess image is everything.

😉

 

[iatrosB]

Does proffesionalism = what you wear?

That IS the point of this thread.

 

[raptor5]

Thinking back a few years ago, I did not find it unprofessional that my physician would wear khakis, a polo shirt, and birks. I actually liked it and felt more comfortable than with those who wore white coats and shirts and ties.

 

[Kevbot]

That IS the point of this thread.

This was the question:

Since Professionalism is becoming a growing theme in the schools, thought that maybe some might want to give some thoughts on this.
Good or Bad & why?

If you can't see past attire in defining proffesionalism then you just proved my point.

 

[cooldreams]

This was the question.


If you can't see past attire in defining proffesionalism then you just proved my point.

getting all hissy with our peers is not leading to much progress.

i believe that coming from many different backgrounds that our social view of professionalism will vary quite widely. just as was spoken above about someones doc being regualar pants and polo, if i were to see my doc like that, i would think they are not taking their visit with me very seriously and cant wait to get BACK out on the golf field... obviously others will take it quite differently.

kevbot, while idealistically i agree with you that visual impressions should not matter in a debate on "professionalism" we are humans with most of our sensory input in the form of eye candy. whether consciously or subconsciously, your attire will matter at least to some extent.

who was it that said that "the best schools" dont care what you wear?? here are a couple of places that do care...

http://cpmcnet.columbia.edu/dept/ps/affairs/handbook0092msdress.html

http://www.southalabama.edu/usahealthsystem/hsf/policyandprocedure/dresscode.html

 

[LukeWhite]

cooldreams,

Both of those dress codes seem to involve what you'd call professional attire only in patient settings. Neither of these deal with the in-class settings that the comments in question referred to. I think you're stretching a bit.

 

[cooldreams]

cooldreams,

Both of those dress codes seem to involve what you'd call professional attire only in patient settings. Neither of these deal with the in-class settings that the comments in question referred to. I think you're stretching a bit.

ah yes, but you see, my "stretching it a bit" is my point. you may see little reason to dress in a "professional manner" while not around patients, however others see a lot of reason.

additionally, most of the other posters either never differentiated between the patient and nonpatient settings or simply talked about the patient settings, all of which makes my examples very much on subject.

sigh.......... sorry guys, i feel like im just arguing now and not really discussing stuff like i intended... im sure many of you will never put on a tie even if your life depended on it, however ill probablly be one of the few ppl in class with a tie on quite often. i feel i look more professional, and that this reflects in my interaction with others around me. i work in a corporate position in a decent sized city, what i talk of is quite normal to do. so to see so many ppl up in arms about wearing even modestly put clothes surprizes me. i supposed that even so, this is what you want to do, so more power to you. if that is what allows you to do your best work, the go for it. any arguement to try to show we are here to put on a show will come up wanting... we are here because we want to be and because we want to help others... so why not do it the best way we can....

time for bed... night ya'll....

 

[iatrosB]

This was the question:

Yeah, you're right. My bad. If you read my posts in this thread, you can see that I believe that attire does not determine professionalism. Sorry for the confusion, I think we are on the same side. 👍

 

[docbill]

Being part of the DO profession.. there is even more importance to be professional (& DRESS PROFESSIONAL). DOs are facing critisism and should beware, they are being watched. As I posted on other threads... Set a good example for your profession. This doesn't only apply to dress code, but also being the best you can be. If you have to learn more on a topic and be extra careful not to seem lazy or less worthy.

 

[LukeWhite]

Being part of the DO profession.. there is even more importance to be professional (& DRESS PROFESSIONAL). DOs are facing critisism and should beware, they are being watched. As I posted on other threads... Set a good example for your profession. This doesn't only apply to dress code, but also being the best you can be. If you have to learn more on a topic and be extra careful not to seem lazy or less worthy.

Maybe we should replace the scrubs in OMM lab with tuxedos?

Dress is neither substitute for nor adjunct to competence. When I see DOs (or their schools) slapping on the extra finery, whatever form it takes, I'm far less likely to think "exceptionally professional" than I am "professionally insecure."

Why not take it one small step further and ditch the degree altogether? If appearances are so crucial, and the osteopathic degree, as you say, invites criticism, it would seem that the most logical course of action would be to scrap it altogether.

Or we could stop worrying about appearance and concentrate on improving competence. But that takes more than a trip to the Gap.

 

[DORoe]

Being part of the DO profession.. there is even more importance to be professional (& DRESS PROFESSIONAL). DOs are facing critisism and should beware, they are being watched. As I posted on other threads... Set a good example for your profession. This doesn't only apply to dress code, but also being the best you can be. If you have to learn more on a topic and be extra careful not to seem lazy or less worthy.

First of all I have never felt that I was "being watched" by anyone (except maybe the CIA they always send those black helicopters to my house, but I've fooled them I have on my tinfoil hat as we speak). Maybe you have a different experience, but I have never felt that I was facing any criticism for being in the osteopathic profession. The only people that take it into account are insecure pre-meds with a superiority complex. LukeWhite makes a very important point when he said, "Dress is neither a substitue for nor adjunct to competence." Learn, study, practice that is what makes a profession and quality doctor. You stated this in your last sentence which I will agree with. Be the best you can be, not because you are a DO, but because you are a doctor and it should be expected of all of us. I find that it is not what you wear, how you talk, but what you do and what you know that determines professionalism.