Clin Med (Lond). 2005 Nov-Dec;5(6 Suppl 1):S5-40.
Medicine bridges the gap between science and society. Indeed, the application of scientific knowledge to human health is a crucial aspect of clinical practice. Doctors are one important agent through which that scientific understanding is expressed. But medicine is more than the sum of our knowledge about disease. Medicine concerns the experiences, feelings, and interpretations of human beings in often extraordinary moments of fear, anxiety, and doubt. In this extremely vulnerable position, it is medical professionalism that underpins the trust the public has in doctors. This Working Party was established to define the nature and role of medical professionalism in modern society. Britain's health system is undergoing enormous change. The entry of multiple health providers, the wish for more equal engagement between patients and professionals, and the ever-greater contribution of science to advances in clinical practice all demand a clear statement of medicine's unifying purpose and doctors' common values. What is medical professionalism and does it matter to patients? Although evidence is lacking that more robust professionalism will inevitably lead to better health outcomes, patients certainly understand the meaning of poor professionalism and associate it with poor medical care. The public is well aware that an absence of professionalism is harmful to their interests. The Working Party's view, based on the evidence it has received, is that medical professionalism lies at the heart of being a good doctor. The values that doctors embrace set a standard for what patients expect from their medical practitioners. The practice of medicine is distinguished by the need for judgement in the face of uncertainty. Doctors take responsibility for these judgements and their consequences. A doctor's up-to-date knowledge and skill provide the explicit scientific and often tacit experiential basis for such judgements. But because so much of medicine's unpredictability calls for wisdom as well as technical ability, doctors are vulnerable to the charge that their decisions are neither transparent nor accountable. In an age where deference is dead and league tables are the norm, doctors must be clearer about what they do, and how and why they do it. We define medical professionalism as a set of values, behaviours, and relationships that underpin the trust the public has in doctors. We go on to describe what those values, behaviours, and relationships are, how they are changing, and why they matter. This is the core of our work. We have also identified six themes where our definition has further implications: leadership, teams, education, appraisal, careers, and research. The Working Party's definition and description of medical professionalism, and the recommendations arising from them, can be found in Section 5 of this report. If our recommendations are acted upon, we believe that professionalism could flourish and prosper to the benefit of patients and doctors alike. However, the exercise of medical professionalism is hampered by the political and cultural environment of health, which many doctors consider disabling. The conditions of medical practice are critical determinants for the future of professionalism. We argue that doctors have a responsibility to act according to the values we set out in this report. Equally, other members of the healthcare team--notably managers--have a reciprocal duty to help create an organisational infrastructure to support doctors in the exercise of their professional responsibilities. Just as the patient-doctor partnership is a pivotal therapeutic relationship in medicine, so the interaction between doctor and manager is central to the delivery of professional care. High-quality care depends on both effective health teams and efficient health organisations. Professionalism therefore implies multiple commitments--to the patient, to fellow professionals, and to the institution or system within which healthcare is provided, to the extent that the system supports patients collectively. A doctor's corporate responsibility, shared as it is with managers and others, is a frequently neglected aspect of modern practice. The audience for this report is, first and foremost, doctors. But we believe it should be of equal interest to patients, policy-makers, members of other health professions, and the media. All these groups have a vital part to play in discussing and advancing medical professionalism. This report is only the beginning of an effort by the Royal College of Physicians, together with others, to initiate a public dialogue about the role of the doctor in creating a healthier and fairer society. Medical professionalism has roots in almost every aspect of modern healthcare. This Working Party could not hope to solve all the issues and conflicts surrounding professionalism in practice today. But our collective and abiding wish is to put medical professionalism back onto the political map of health in the UK.
医学架起了科学与社会之间的桥梁。的确，将科学知识应用于人类健康是临床实践的一个关键方面。医生是表达这种科学理解的一个重要媒介。但医学不仅仅是我们关于疾病的知识总和。医学涉及人类在恐惧、焦虑和怀疑等常常非同寻常的时刻的经历、感受和解读。在这种极其脆弱的状态下，正是医学专业精神支撑着公众对医生的信任。设立这个工作小组是为了界定医学专业精神在现代社会中的本质和作用。英国的医疗体系正在经历巨大变革。多个医疗服务提供者的加入、患者与专业人员之间更平等互动的愿望，以及科学对临床实践进步的贡献日益增大，所有这些都要求明确阐述医学的统一目标和医生的共同价值观。什么是医学专业精神，它对患者重要吗？尽管缺乏证据表明更强有力的专业精神必然会带来更好的健康结果，但患者肯定理解糟糕的专业精神的含义，并将其与糟糕的医疗服务联系起来。公众清楚地意识到缺乏专业精神对他们的利益有害。基于所收到的证据，工作小组的观点是，医学专业精神是成为一名好医生的核心。医生秉持的价值观为患者对其医疗从业者的期望设定了标准。医学实践的特点是在面对不确定性时需要做出判断。医生要对这些判断及其后果负责。医生最新的知识和技能为这些判断提供了明确的科学依据，而且往往还有隐含的经验依据。但由于医学中有太多不可预测的情况需要智慧以及技术能力，医生容易受到这样的指责，即他们的决策既不透明也无法问责。在一个崇尚质疑、排名表成为常态的时代，医生必须更清楚地说明他们做什么、如何做以及为何这样做。我们将医学专业精神定义为一系列价值观、行为和关系，这些支撑着公众对医生的信任。我们接着描述这些价值观、行为和关系是什么，它们如何变化以及为何重要。这是我们工作的核心。我们还确定了六个主题，在这些主题中我们的定义有进一步的影响：领导力、团队、教育、评估、职业发展和研究。工作小组对医学专业精神的定义和描述以及由此产生的建议可在本报告第5节中找到。如果我们的建议得到实施，我们相信专业精神能够蓬勃发展，造福患者和医生。然而，医学专业精神的践行受到健康领域政治和文化环境的阻碍，许多医生认为这种环境令人无能为力。医疗实践条件是专业精神未来的关键决定因素。我们认为医生有责任按照我们在本报告中阐述的价值观行事。同样，医疗团队的其他成员——尤其是管理人员——有相应的责任帮助创建一个组织架构，以支持医生履行其专业职责。正如医患关系是医学中关键的治疗关系一样，医生与管理人员之间的互动对于提供专业护理至关重要。高质量的护理取决于有效的医疗团队和高效的医疗组织。因此，专业精神意味着多重承诺——对患者、对同行专业人员以及对提供医疗服务的机构或系统，只要该系统能集体支持患者。医生的共同责任，与管理人员和其他人员共同承担，是现代实践中一个经常被忽视的方面。本报告的首要受众是医生。但我们认为患者、政策制定者、其他医疗专业的成员以及媒体也会同样感兴趣。所有这些群体在讨论和推进医学专业精神方面都能发挥至关重要的作用。本报告只是皇家内科医师学院与其他机构共同努力的开始，旨在就医生在创建一个更健康、更公平社会中的作用展开公众对话。医学专业精神几乎扎根于现代医疗保健的方方面面。这个工作小组无法期望解决当今围绕实践中专业精神的所有问题和冲突。但我们共同且持久的愿望是将医学专业精神重新置于英国健康领域的政治版图上。
