Mark J. Lema, M.D., Ph.D. Editor

Professionalism and the Anesthesiologist: I’ll Know It When I See It

Professionalism — it’s an elusive, intangible concept. Yet every career has a code of conduct, a prototypic look and a public expectation. When identified as a professional engaged in a certain career’s activities, the public has a perception of that person’s countenance, demeanor and knowledge. Restated in today’s terms, people expect professionals to “look the look, talk the talk and walk the walk.”

Society takes comfort in being serviced by professionals who meet their generally acceptable standards. Conversely, people are wary of individuals who do not look, act or talk like a professional. Imagine boarding a commercial airplane being greeted by a pilot in jeans, a flannel shirt and a baseball cap turned backward. I would suspect that a wave of uneasiness would overcome your mind. Now consider being introduced to a well-dressed politician, who when speaking, repeatedly used incorrect grammar and vulgar expressions. Finally, think about a conversation with your dentist, who was articulate, appropriately dressed, yet could not adequately explain why your wisdom teeth needed removal.

Professionalism is, therefore, a package of the right look, the right presentation and the correct knowledge to make the customer, client or patient confident that the best care or service is being provided. In the ASA monograph “Starting Out: A Practice Management Guide for Anesthesiology Residents,” professionalism is defined as:

“… a set of values, attitudes and behaviors that focuses on commitment to service. Among the core attitudes and behaviors expected of medical professionals are integrity, availability, accountability and altruism.”

Thus medical professionalism is more than a professional image, verbal articulation and a photographic memory. A medical professional, according to the esteemed surgeon Francis (Frannie) Moore, M.D., is summed up as follows:

“The fundamental act of medical care is assumption of responsibility … complete responsibility for the welfare of the patient.”¹

Dr. Moore went on to state that a good doctor “employs any effective means available [for the patients’s welfare].”¹

In practice, professionalism is having respect for patients and families first and for one’s self and colleagues second. Concepts such as compassion, honesty, commitment, respect, responsibility and preparedness embody the making of a true medical professional.

The doctors of yesteryear needed to overcome the skepticism of a society that experienced traveling medicine salesmen, quacks and inferior medical schools (a.k.a., the Flexner Report). Today, with medicine firmly established as a noble practice, some doctors must overcome perceptions of narcissism, greed, disinterest and unavailability. Despite the frustrations experienced by doctors in a changing health care environment, professionalism is the quintessential element for medicine’s survival in society as we know it.

The Institute of Medicine (IOM) is continuing to strategize a new paradigm for medical care in the next few decades and has outlined its plans in a brief summary document on its Web site.² IOM’s aims are succinct and have been reported in a previous “Ventilations” article.³

According to IOM, health care should be:

• Safe

• Effective

• Patient-centered

• Timely

• Efficient

• Equitable

Throughout the treatise, a high degree of professional ethics is assumed.

In assessing one’s attitudes and practices, walking the walk, talking the talk and looking the look must be applied to one’s daily activity in order to be successful. After reading a number of articles on professionalism, I have honed down the information into a few suggested and albeit incomplete guidelines for being successful in becoming and being perceived as a true medical professional.

Improving One’s Professional Image

1. Walk the Walk

• Strive to be the best physician you can be.

• When making patient care decisions, be empathetic.

• Always ask “should we do this?” not “can we do this?”

• Participate in professional society and hospital committee work.

• Remember that the practice of medicine requires lifelong learning.

• Be willing to accept responsibility for your patient’s care.

2. Talk the Talk

• Provide patients with simplified, straightforward medical information.

• Be honest but consoling and respectful.

• Avoid talking about patients in public, especially if the comments are denigrating.

3. Look the Look

• Remember that you dress for your patients and your referring physicians.

• Being overdressed is almost as bad as being underdressed (one may look too “slick”).

• Be aware of your actions, posture and tone of voice when in professional settings.

• Be a good citizen in your community by taking an active role in municipal projects or planning meetings.

• Your appearance is a nonverbal form of communication.

In summary, one should strive to be recognized as a compassionate, caring physician who provides excellent medical care. A simple daily check to see if you meet this ideal might be to:

• Put a large mirror on the door in your office.

• Stand in front of the mirror and think about what you intend to do for your patients on that day.

• Ask yourself, “Would I want someone to care for me who looks like me, doing what I intend to do and telling it to me in the way I would speak to them?”

If the answer is “yes,” you have most likely met the challenge (or are hopelessly sadomasochistic!).

– M.J.L.

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