Following the publication of Advancing medical professionalism, Point of Care Foundation chief executive Jocelyn Cornwell discusses how it aligns with her organisation's goals and findings.
Last week the RCP published Advancing medical professionalism, a report that set out an updated vision for what professionalism means for today’s doctors. The last time this was done was 2005 – and, as the report observes, a lot has changed since then. New technologies, changing organisational structures and increased demand as people live longer- often with long-term conditions and multiple morbidities – have all contributed to a change in the context within which doctors (and all other health workers) operate. Disputes about pay and conditions, fuelled by funding restrictions, and high-profile cases of harm to patients, have thrown the question of what professionalism means into the spotlight.
At the Point of Care Foundation we take a keen interest in medical professionalism. We do this from two main angles: the first is our concern for the quality of patient care and how to support health professionals to deliver it in a more patient-centred way; the second, an extension of the first, is our focus on the wellbeing of the people delivering care. We recognise that to be present with patients and responsive to their individual differences, people delivering care need to be well and feel supported. We think how the medical professions operate must be part of the solution to this.
We recognise that to be present with patients and responsive to their individual differences, people delivering care need to be well and feel supported
Our own interest in the relationships between professionals and patients led us to commission an audit of how medical schools were teaching medical professionalism to undergraduates, and we fed these findings into some recommendations for medical schools, now published on the GMC’s website. The focus on how (and whether) professionalism is taught ‘upstream’ to undergraduates complements the RCP’s views on professionalism ‘downstream’ for practising professionals. Integrated together, the two should offer an approach to professionalism that extends from initial medical training right through the careers of all health professionals.
We don’t need to rehearse all aspects of the RCP’s vision for the modern medic in this blog, but there are some aspects of it that the Point of Care Foundation, with our twin focuses on patient centred quality improvement and staff wellbeing, would emphasise.
Humanity in healthcare
The first, over-arching role for the modern doctor is presented in the RCP report in terms of ‘the doctor as healer’. This role is wider than the technical aspects of treatment and encompasses many of the non-medical aspects of the patient’s experience of engaging with the doctor.
For example, the report describes the importance of engaging patients as people – by being open, removing barriers and listening actively. This relates strongly to what we have found through our quality improvement work to make a big difference to patients. Sometimes it takes a process of trying to connect with patients’ experiences and directly observing the care that is delivered (as opposed to the care that is imagined) to fully grasp the reason why it is often small changes that make a big difference.
Working in partnership with patients
The report explains how the nature of doctor-patient relationships has changed. Patients are no longer automatically deferential to doctors and we believe the most effective care reflects a more equal partnership. In the increasingly specialised world of medicine, professionals need to help patients negotiate the system to access the right care. This focus on ‘the doctor as patient partner’ emphasises the value that patients themselves can bring to healthcare, but challenges doctors to share power and work differently.
[We know] how difficult it is for staff to acknowledge their own vulnerabilities and needs and how beneficial it can be to talk to others
Self-care for doctors
How doctors look after themselves is an important theme. The report argues that the public expects professionals to put patients’ interests first, but acknowledges that ‘putting patients first cannot mean that doctors seriously harm their own health’. We know, from our work with Schwartz Rounds, how difficult it is for staff to acknowledge their own vulnerabilities and needs and how beneficial it can be to talk to others. Newly published evidence shows that people who regularly take part in Schwartz Rounds experience psychological distress at half the rate of colleagues who don’t attend.
Among our recommendations for medical schools is that students have access to a safe space for sharing their thoughts and experiences in an open way (such as that provided by Schwartz Rounds), to help deal with the stresses of medical learning and to develop, early on, a habit of reflection with others.
This report, and our exploration of how professionalism is taught in medical schools, reflects the importance of professionalism at the moment. The hope for the RCP’s work, expressed in the report, is that many aspects of it will be taken forward by doctors themselves. But it also looks ahead to cooperation with other bodies to form a working group, to include doctors as well as patients, other health professionals and managers. We believe this is crucial. It has been just 13 years since medical professionalism was last defined in this way, and it seems likely that it will need further refinement as the context for healthcare professionals continues to evolve. A focus on the essential humanity of healthcare, active support for doctors throughout their careers and enabling them to stay in touch with the initial motivations that brought them into the profession, must remain at the core of medical professionalism.
- Advancing medical professionalism has been developed by the RCP in consultation with healthcare professionals, patients and other stakeholders to help doctors improve their professionalism in practical ways. The full report is now available to download.