Moral professionalism should include advocacy and duty

Across the nation, the medical calendar starts in July, not January. Every July 1, hospitals are infused with new, eager interns who have just graduated from medical school. To get off to a good July start, I give a talk to the obstetrical and gynecology interns and residents about medical professionalism. It is mandated (and rightly so) by the ACGME (Accreditation Council for Graduate Medical Education) that we teach, mentor and measure professionalism. The definition of professionalism includes three domains including relationships (communication, teamwork, and teaching others), habits of mind (self reflection, recognition of biases, and correction of errors), and moral responsibility (tolerance, respect for others, and caring).

The week before I was scheduled to give my professionalism talk to the residents, the Supreme Court upheld the Affordable Care Act. I reflected on this historical event, as to what does this mean for young physicians starting their journey into medicine? For women’s health care providers, it means expanded health care coverage for all. This includes comprehensive maternity and well-woman care, no longer denying coverage on the basis of previous cesarean delivery, history of domestic violence or other pre-existing medical conditions. However, an additional overtone should include heightened moral professionalism, which embraces justice, advocacy and duty.

After the Supreme Court announcement, Atul Gawande, a physician writer, wrote a blog for The New Yorker. He defined the major social advances of the past three centuries which included freedom of speech and religion; the right to vote; government-assured minimal levels of education; economic well-being; and security. He advocated that “We are all born frail and mortal—and, in the course of our lives, we all need health care.” Dr. Gawande observed that all major social advances required widening our sphere of moral inclusion.

Donald Berwick gave the Harvard Medical School Class Day Speech this spring. Dr. Berwick is the former President and CEO of the Institute of Healthcare Improvement; and former Administrator, Centers for Medicare and Medicaid Services (CMS). In his speech to the graduating medical students, he focused his talk on putting patients first and our morals and obligations as a nation. He noted the inscription on the CMS Hubert Humphrey Building, “The moral test of government is how it treats people in the dawn of life, the children, in the twilight of life, the aged, and in the shadows of life, the sick, the needy, and the handicapped.”

No one knows what healthcare reform will truly bring. However, I told the young physicians that we should consider expanding the definition of moral professionalism to include advocacy and duty and that we are fortunate to be practicing medicine in the dawn of a new social era. It is a good time to be an intern…and a Chair.

Vivian von Gruenigen is Chair, Obstetrics and Gynecology, Summa Akron City and St. Thomas Hospitals in Akron, Ohio, and System Medical Director, Women’s Health,  Summa Health System. She is a professor at Northeast Ohio Medical University. She can be reached on Twitter @DoctorViv and blogs at flouish.

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