letters to the editor
Becoming professional: one physician’s RRRRRRRRRReflections on professionalism William Ventres1,2 Editor – I read with pleasure the recent article on professionalism by Brody and Doukas.1 I especially appreciated how they moved the idea of professionalism away from a checklist of ‘Do Nots’ and positioned it in the midst of the public and private relationships that doctors have with patients, with society as a whole, and with their own consciences. Although I believe my most important teaching on the subject happens subtly as part of day-to-day interaction with students, during formal instruction I emphasise that professionalism is more of a process than a state of being. As physicians we work hard and with intent to conduct ourselves professionally; we also make mistakes and are sometimes blind to forces that impair our judgements and subsequent behaviours. With the inner sense of virtue that Brody and Doukas1 review, aided by colleagues and others, may we hope to recognise our occasional errant blunders and get ‘back on track’ sooner rather than later.
I use the letter R, repeated 10 times – RRRRRRRRRR – to refer to steps along this process-oriented path to professionalism. These steps, in no particular order, include:
1 Institute for Studies in History, Anthropology and Archaeology, University of El Salvador, San Salvador, El Salvador 2 Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
Responsibility – taking ownership of one’s role as a physician and its development over time; Reflection – contemplating interpersonal understanding and intrapersonal awareness, as deeply as is possible; Responsiveness – attending to relational dimensions of medical care, both technical and humanistic; (Auto)Regulation – practising mindfulness in the moment and developing a non-anxious presence in the face of challenging situations;2, 3 Regression, Recognition and Redirection – handling situations in which our behaviour has been less than professional; Remembrance and Reconciliation – not forgetting, but forgiving, and Reformation – acknowledging that the commodification of care and many other institutional powers threaten profes-
sionalism in medicine, and working, as far as we are able, to oppose those insidious influences.4 Professionalism is a concept that we embody over time, with resolve, awareness and compassion. It is not, as Brody and Doukas1 point out, a superficial management of deficits. Professionalism is more precisely a long and winding road to be walked with dignity, respect and integrity. It is a process of becoming,5 one that touches deeply within our souls as agents of healing.
REFERENCES 1 Brody H, Doukas D. Professionalism: a framework to guide medical education. Med Educ 2014;48:980–7. 2 Epstein RM. Mindful practice in action (II): cultivating habits of mind. Fam Syst Health 2003;21:11–7. 3 Rogers C. On Becoming a Person. Boston, MA: Houghton Mifflin Company 1961. 4 Relman AS. Medical professionalism in a commercialised health care market. JAMA 2007;298:2668–70. 5 Palmer PJ. Let Your Life Speak: Listening to the Voice of Vocation. San Francisco, CA: John Wiley & Sons 2000.
Correspondence: William Ventres, Institute for Studies in History, Anthropology and Archaeology, University of El Salvador, Urbanizaci on Buenos Aires III, Block H, Calle Los Maquilishuat, No. 3-A, San Salvador, El Salvador. Tel: 00 503 7193 9830; E-mail: [email protected] doi: 10.1111/medu.12627
544
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 542–544
Becoming professional: one physician’s RRRRRRRRRReflections on professionalism William Ventres1,2 Editor – I read with pleasure the recent article on professionalism by Brody and Doukas.1 I especially appreciated how they moved the idea of professionalism away from a checklist of ‘Do Nots’ and positioned it in the midst of the public and private relationships that doctors have with patients, with society as a whole, and with their own consciences. Although I believe my most important teaching on the subject happens subtly as part of day-to-day interaction with students, during formal instruction I emphasise that professionalism is more of a process than a state of being. As physicians we work hard and with intent to conduct ourselves professionally; we also make mistakes and are sometimes blind to forces that impair our judgements and subsequent behaviours. With the inner sense of virtue that Brody and Doukas1 review, aided by colleagues and others, may we hope to recognise our occasional errant blunders and get ‘back on track’ sooner rather than later.
I use the letter R, repeated 10 times – RRRRRRRRRR – to refer to steps along this process-oriented path to professionalism. These steps, in no particular order, include:
1 Institute for Studies in History, Anthropology and Archaeology, University of El Salvador, San Salvador, El Salvador 2 Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
Responsibility – taking ownership of one’s role as a physician and its development over time; Reflection – contemplating interpersonal understanding and intrapersonal awareness, as deeply as is possible; Responsiveness – attending to relational dimensions of medical care, both technical and humanistic; (Auto)Regulation – practising mindfulness in the moment and developing a non-anxious presence in the face of challenging situations;2, 3 Regression, Recognition and Redirection – handling situations in which our behaviour has been less than professional; Remembrance and Reconciliation – not forgetting, but forgiving, and Reformation – acknowledging that the commodification of care and many other institutional powers threaten profes-
sionalism in medicine, and working, as far as we are able, to oppose those insidious influences.4 Professionalism is a concept that we embody over time, with resolve, awareness and compassion. It is not, as Brody and Doukas1 point out, a superficial management of deficits. Professionalism is more precisely a long and winding road to be walked with dignity, respect and integrity. It is a process of becoming,5 one that touches deeply within our souls as agents of healing.
REFERENCES 1 Brody H, Doukas D. Professionalism: a framework to guide medical education. Med Educ 2014;48:980–7. 2 Epstein RM. Mindful practice in action (II): cultivating habits of mind. Fam Syst Health 2003;21:11–7. 3 Rogers C. On Becoming a Person. Boston, MA: Houghton Mifflin Company 1961. 4 Relman AS. Medical professionalism in a commercialised health care market. JAMA 2007;298:2668–70. 5 Palmer PJ. Let Your Life Speak: Listening to the Voice of Vocation. San Francisco, CA: John Wiley & Sons 2000.
Correspondence: William Ventres, Institute for Studies in History, Anthropology and Archaeology, University of El Salvador, Urbanizaci on Buenos Aires III, Block H, Calle Los Maquilishuat, No. 3-A, San Salvador, El Salvador. Tel: 00 503 7193 9830; E-mail: [email protected] doi: 10.1111/medu.12627
544
ª 2015 John Wiley & Sons Ltd. MEDICAL EDUCATION 2015; 49: 542–544
