Absent Joy, Can Medicine Sustain Professionalism?

Posted on | February 10, 2010 | Comments Off on Absent Joy, Can Medicine Sustain Professionalism?

Eli Ginzberg PhD (1911 – 2002)

Here’s the question: Is is possible to sustain professional behavior in a setting that is incapable of supporting personal and professional growth, and a system where money trumps joy most of the time?

Last week, I had the opportunity to spend two days at the University of North Carolina at the School of Medicine and the School of Public Health. One of the issues we discussed was “Advanced Professionalism”, an approach to professionalism where values define practice; and thoughtful, forward facing, customized and predictive health system design define potential for professional success. Over the past 5 weeks, we’ve covered in this space the values health organizations have associated with autonomous professional behavior; the continued tendency to associate measures of professionalism with hospital-centric performance; the voicing of consumer inclusion without true involvement of consumers in system redesign; the limitations in realizing professionalism in obstructive disintegrated systems; and finally the impact that a movement toward preventive and predictive health care might have on the definition of what it means to be a professional. (1-5)

One piece of this entire puzzle not addressed is the human resource implications of moving to a professional preventive system where strategic health planning is the major deliverable. Clearly, success would require that everyone (including physicians) take a fresh look at their job descriptions. To do prevention effectively you need a team approach and active team membership and participation for the patients you are pledged to support. The needs of these teams and the skill mix in an enterprise dominated by information and planning would be quite different than our current inpatient teams in labor and delivery or surgical suites or emergency departments. We mouth often our commitment to prevention without ever really acknowledging how fundamentally disruptive such a move would be to our current workforce, measures of success and reward systems, and our educational enterprises which would have to fundamentally transform curricula to deliver the appropriate skills sets and competences for a very different challenge.

Anyway, getting back to UNC, I was touring their new Cancer Center with a young faculty surgical oncologist who was clearly happy to be in Chapel Hill. (CONTINUE …)