Medicine, like other professions, is guided by well engrained principles, codes of conduct, and a shared belief in the integrity and professionalism of its practitioners. As a surgeon, and as the Executive Director and CEO of the CMPA, I have seen physicians questioned—and questioning themselves—about what professionalism in medicine means today. This is not a strictly philosophical question, as we at the CMPA see during our interactions with practising physicians every day. Lapses in civility and eroded trust can have real and profound consequences for physicians and the way in which they are perceived.
Despite suggestions to the contrary, I believe medical professionalism is as strong today as ever. What has changed is the culture of the healthcare workplace. Until the 1960s the focus of physicians was almost entirely on the clinical aspects of medicine. From the 1960s to the 2000s the focus increasingly shifted to measurement and "performance management," largely in response to rising demands on the healthcare system for improved access in a time of constrained budgets. Though the mantra of "doing more with less" may have seemed logical, it also left many practitioners feeling discouraged and frustrated, and at times, this new reality resulted in behaviours that were inconsistent with the ideals to which we strive.
Today, we are on the cusp of what the founder of the Institute for Healthcare Improvement, Dr. Donald Berwick, calls the "moral era," in which we develop a more robust professional self-identify that encompasses an emotional quotient and greater cultural sensitivity. There exists a desire to reimagine "who I am"—whether in our personal lives as parents, grandparents, children, or siblings; or in our work as healthcare professionals interacting with colleagues, patients, clinic managers, and so on. There is a will to build a system of care we can all rely on when we need it as patients, and of which we can be proud as health providers.
Physicians are confronted with competing objectives: on the one hand lies the business imperative to deliver healthcare services efficiently and at the lowest possible cost. On the other, is the professional imperative of excellence and of having the latitude to exercise professional judgment. Physicians can reconcile these forces only on the basis of trust—with colleagues, other care providers, patients, employers, governments. Re-establishing and preserving such trust is fundamental to a "just" culture in healthcare, a culture that encourages accountability but resists blaming or shaming when difficulties arise.
I am pleased with the CMPA’s work in supporting physicians during these challenging times. This work includes tackling high-risk areas of medicine using a holistic approach to change cultural assumptions. It means providing training for hospital leaders to foster trusting relationships, design fair and transparent processes, and stage early interventions for physicians in difficulty. And it means offering more comprehensive educational opportunities for those physicians who may be struggling.
2017 promises to be a watershed year for the Association, and I look forward to sharing more news with you about the CMPA’s work in these and other areas in the months ahead. "Empowering better healthcare" is more than just a tag line: it’s our promise.
Hartley Stern, MD, FRCSC, FACS