Professionalism in Psychiatry
Although the major tenets and important branches of medical and psychiatric professionalism are contained in our hallowed source documents—the Hippocratic Oath, the Oath of Maimonides, and the Declaration of Geneva Physician’s Oath—ongoing evolution in the professions and in society demands that we constantly review, refine, and update our thinking about these values and practices.
Accordingly, the Accreditation Council for Graduate Medical Education has included professionalism as one of the 6 "core competencies" of medical education. Among the attitudes, knowledge, and skills comprising this domain are requirements that physicians adhere to a number of historically well-understood ethical principles, including attention to increasing quality of care, access to care, scientific knowledge, and practicing competently within one’s scope of practice. These requirements have generally been operationalized as manifesting respect, compassion, integrity, and honesty; being responsive to the needs of patients and society in a manner that supercedes self-interest; being accountable to patients, society, and the profession; respecting patient privacy and autonomy; maintaining professional boundaries; being sensitive and responsive to diverse populations; and being transparent about and managing conflicts of interest that may affect care. Rapid shifts in cyberspace technology and sociocultural forces shaping practice (including such things as electronic medical records, bureaucratic and regulatory forces, the industrialization of medical practice, and multiple methods of anyone-to-anyone instantaneous 24/7 communications by e-mail, social media, and videophone) further threaten professionalism and complicate many of the ethical issues physicians currently face. And since in mental health fields the nature of clinician-patient relationships (including particular concerns regarding privacy) and the problems being treated are somewhat unique, psychiatrists are also expected to understand and practice in accord with the many nuances of professionalism inherent in these issues.
To help address these needs, Glen Gabbard, Laura Weiss Roberts, Holly Crisp-Han, Valdesha Ball, Gabrielle Hobday, and Funmilayo Rachal, a wonderful mix of esteemed authorities and talented young colleagues, have prepared a brief, highly readable, learner-friendly text that should serve the needs of students, trainees, and experienced practitioners. The main issues concerning professionals in psychiatry are clearly laid out and systematically considered. Literature supporting and backing up discussions is highly up to date, and key points are succinctly summarized at the end of each of the 10 chapters.
Although egregiously unprofessional behaviors among physicians that actually result in formal professional discipline may be relatively rare (in a Canadian study,1 rates of physicians subject to professional discipline were 0.06%-0.11% per year), subtle acts of irresponsibility; disruptive physician misbehaviors; mistreatments based on ethnic, racial, and gender biases; boundary violations and unprofessional crossings; mishandled dual roles and conflicts of interest; poor interpersonal and interprofessional relations in organizations based on hierarchy, rivalry, and stigma; and the unintended lessons transmitted via the "hidden curriculum" in educational settings (through which learners model what their teachers—who sometimes set bad examples—actually do, rather than simply what they say) are unfortunately not uncommon in everyday life. All of these topics and more are addressed in this fine book. Since ethical decision-making and practice in psychiatry occur in the context of complex and sloppy real-world situations, the authors present case vignettes throughout the book that provoke thought and discussion.
The book can serve as an excellent, accessible text for professionalism seminars in residency programs; as a study guide for continuing medical education in postgraduate, ongoing peer-learning, and professional association settings; or simply as an excellent starting point for self-examination for individual practitioners. As I read this book, I found that I was checking myself out—reflecting on my own behavior with many of my patients, colleagues, and students and wondering about where I might have occasionally slipped and where I might do things better. That’s the whole point.
Reference
1. Alam A, Kurdyak P, Klemensberg J, et al. The characteristics of psychiatrists disciplined by professional colleges in Canada. PLoS ONE. 2012;7(11):e50558. PubMed doi:10.1371/journal.pone.0050558
Author affiliation: University of Colorado School of Medicine, Aurora.
Potential conflicts of interest: None reported.
J Clin Psychiatry 2014;75(7):e710 (doi:10.4088/JCP.14bk09108).
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