Transcript www.medschool.vcu.edu

Professionalism and
Mental Health
Cheryl S. Al-Mateen, MD, FAACAP, FAPA
Department of Psychiatry
VCU School of Medicine
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Overview
• Professionalism – what is it?
• Professionalism at MCV
• Vignettes
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Learned Professions
• Law
• Religion
• Medicine
• Nursing
• Occupational
Therapy
• Psychology
• Recreation
Therapy
• Social Work
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The Oath of Hippocrates
I do solemnly swear by that which I hold most
sacred
That I will be loyal to the profession of medicine
and just and generous to its members
That I will lead my life and practice my art in
uprightness and honor
That into whatsoever house I shall enter it shall
be for the good of the sick to the utmost of my
power, I holding myself aloof from wrong,
from corruption, from tempting of others to
vice
That I will exercise my art solely for the cure of
my patients, and will give no drug, perform no
operation, for a criminal purpose, even if
solicited, far less suggest it
That whatsoever I shall see or hear of the lives of
men which is not fitting to be spoken, I will
keep inviolably secret…….
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Psychology
• General Principles
– Beneficence and
nonmaleficence
– Fidelity and responsibility
– Integrity
– Justice
– Respect for people’s
rights and dignity
• Ethical standards
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Resolving ethical issues
Competence
Human relations
Privacy and
confidentiality
Advertising
Record keeping and fees
Education and training
Research and publication
Assessment
Therapy
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Social Work
• Ethical principles
– primary goal is to help
people in need and to
address social problems
– challenge social injustice
– respect the inherent dignity
and worth of the person
– recognize the central
importance of human
relationships
– behave in a trustworthy
manner.
– practice within their areas of
competence and develop
and enhance their
professional expertise
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Ethical standards
– Responsibilities to clients
– Responsibilities to
colleagues
– Responsibilities in practice
settings
– Responsibilities as
professionals
– To the profession
– To broader society
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American Psychiatric Nurse’s Association/American
Nurse’s Association
• Provision 1. …practices with compassion and respect for
the inherent dignity, worth, and uniqueness of every
individual, unrestricted by considerations of social or
economic status, personal attributes, or the nature of health
problems.
• Provision 2: ...primary commitment is to the patient,
whether an individual, family, group, or community.
• Provision 3: promotes, advocates for, and strives to protect
the health, safety, and rights of the patient.
• Provision 4: is responsible and accountable for individual
nursing practice and determines the appropriate delegation
of tasks consistent with the nurse's obligation to provide
optimum patient care
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American Nurses’ Association, cont’d
• Provision 5: owes the same duties to self as to others,
including the responsibility to preserve integrity and safety,
to maintain competence, and to continue personal and
professional growth.
• Provision 6: participates in establishing, maintaining, and
improving health care environments and conditions of
employment conducive to the provision of quality health
care and consistent with the values of the profession
through individual and collective action.
• Provision 7. The nurse participates in the advancement of
the profession through contributions to practice, education,
administration, and knowledge development.
• Provision 8. The nurse collaborates with other health
professionals and the public in promoting community,
national, and international efforts to meet health needs.
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American Therapeutic Recreation Association
– Beneficence/non-maleficence
– Autonomy
– Justice
– Fidelity
– Veracity/Informed Consent
– Confidentiality and Privacy
– Competence
– Compliance with Laws and Regulations
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Occupational therapy
Occupational therapy personnel shall…
– demonstrate a concern for the well-being of the recipients of their
services (beneficence)
– take reasonable precautions to avoid imposing or inflicting harm upon
the recipient of services or to his or her property (nonmaleficence)
– respect the recipient and/or their surrogates as well as the recipient’s
rights (autonomy, privacy, confidentiality)
– achieve and continually maintain high standards of competence
(duties)
– comply with laws and Association policies guiding the profession of
occupational therapy (justice)
– provide accurate information about occupational therapy services
(veracity)
– treat colleagues and other professionals with fairness, discretion, and
integrity (fidelity)
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ACGME
Residents must demonstrate a
commitment to carrying out
professional responsibilities,
adherence to ethical principles, and
sensitivity to a diverse patient
population
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Charter on Medical Professionalism
Professionalism is the basis of medicine’s
contract with society. It demands placing the
interests of patients above those of the physician,
setting and maintaining standards of competence
and integrity, and providing expert advice to
society on matters of health. The principles and
responsibilities of medical professionalism must
be clearly understood by both the profession and
society. Essential to this contract is public trust in
physicians, which depends on the integrity of
both individual physicians and the whole
profession.
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Charter on Medical Professionalism
• Commitments
• Principles
– Primacy of patient
welfare
– Patient autonomy
– Social justice
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Professional competence
Honesty with patients
Patient confidentiality
Maintaining appropriate
relations with patients
Improving quality of care
Improving access to care
Just distribution of finite
resources
Scientific knowledge
Maintaining trust by
managing conflicts of
interest
Professional
responsibilities
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Professionalism at MCV
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The AMA Council on Ethical and Judicial Affairs (1980)
A physician shall…
1) be dedicated to providing competent medical service with compassion and
respect for human dignity.
2) be honest with patients and colleagues and strive to expose those
physicians deficient in character or competence or who engage in fraud or
deception.
3) respect the law and a responsibility to seek changes in those requirements
that are contrary to the best interests of the patient.
4) respect the rights of patients/colleagues and of other health professionals
and shall safeguard patient confidences within the constraints of the law.
5) continue to study, apply and advance scientific knowledge, make relevant
information available to patients, colleagues, and the public, obtain
consultation and use the talents of other heath professionals when
indicated.
6) in the provision of patient care, except in emergencies, be free to choose
whom to serve, associate with, and the environment in which to provide
medical services.
7) recognize a responsibility to participate in activities contributing to an
improved community.
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Sources of Concern re: Professionalism
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Medical student graduation questionnaire
AMA
AAMC
ACGME
LCME
ABIM
Local anecdotes
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VCU SOM Professionalism Task Force
Report - 2001
– Reviewed definitions
– Assess MCV campus environment
– Develop goals for enhancing MCV
environment
– Assist Dean’s office in maintaining
professionalism
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VCU SOM Professionalism Task Force
Conclusions and Tasks
– All unprofessional behavior is unacceptable….corrective
actions will be necessary
– Enhancing professionalism among the faculty, who
serve as role models for others, will have a beneficial
effect on these groups
– There is limited evaluation of individual faculty members
and students of professionalism in our school. A new
series of evaluation processes is necessary
– We need specific policies to deal with transgressions in
professionalism
– We need coursework on professionalism
– A program to increase the awareness of medical
professionalism in the entire community of VCU SOM
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Components of Medical Professionalism
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Altruism
Accountability
Excellence
Respect for others
Personal commitment to life-long learning
Duty
Honor and integrity
(KUMC definition)
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Challenges to Professionalism
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Abuse of power
Discrimination
Bias
Breach of
confidentiality
• Arrogance
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Greed
Misrepresentation
Impairment
Lack of
conscientiousness
• Conflict of interest
(KUMC definition)
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Unprofessional Behavior
Unmet professional responsibility
Lack of effort toward selfimprovement and adaptability
Poor interaction with patients and
families
Inappropriate relationships with
health care professionals
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Teacher-learner relationship
– Mutual trust
– Respect
– Responsibility
– Professional manner
– Focus on education
– High quality patient care
– Ethical conduct.
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Vignettes
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A patient witnesses her
kitten being mauled and
killed by a pit bull. She is
in significant distress. She
has taken a picture of the
cat for legal purposes.
She has come to you for
treatment of anxiety
symptoms. She wants to
show you the pictures,
indicating that she feels
you cannot understand the
depth of her grief without
seeing the pictures.
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Tape Vignettes
How could this
situation present in
mental health
training?
How should it be
handled?
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VCU School of Medicine Standards
of Professional Behavior
These standards describe behaviors expected from
faculty, housestaff, and students in the School of Medicine:
• Recognize their positions as role models for other
members of the health care team.
• Carry out academic, clinical and research
responsibilities in a conscientious manner, make
every effort to exceed expectations and make a
commitment to life-long learning.
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• Treat patients, faculty, housestaff and students with
humanism and sensitivity to the value of cultural,
social, age, gender, disability and economic diversity
without discrimination, bias, or harassment.
• Maintain patient confidentiality.
• Be respectful of the privacy of all members of the
medical campus community and avoid promoting
gossip and rumor.
• Interact with all other members of the health care
team in a helpful and supportive fashion without
arrogance and with respect and recognition of the
roles played by each individual.
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• Provide help or seek assistance for any member of
the health care team who is recognized as impaired in
his/her ability to perform his/her professional
obligations.
• Be mindful the limits of one’s knowledge and abilities
and seek help from others whenever appropriate.
• Abide by accepted ethical standards in the
scholarship, research and standards of patient care.
• Abide by the guidelines of the VCU Honor System.
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“Bottom Line”
Medical Professionalism is an expected
behavior in all interactions
• Faculty
• Housestaff
• Support staff
• Students
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DEPARTMENT OF PSYCHIATRY
EVALUATION OF RESIDENT'S PERFORMANCE
PROFESSIONALISM
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2
3
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5
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Respect/Compassion
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Ethics/Integrity
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Cultural/Ethnic Sensitivity
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2
3
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5
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Demeanor/Bearing/Appearance
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Punctuality/Attendance
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Faculty Evaluation for
Professionalism
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Professionalism Committee Process
Discuss/guidance
Student
Housestaff
Faculty
Professionalism
Committee
Modified Informal
Complaint
Refer
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School of medicine professionalism contact committee
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Dr. Karen Sanders (Chair), VAMC
Dr. Cheryl Al-Mateen, Psychiatry
Dr. Diane Biskobing, Internal Medicine
Dr. Melissa Bradner, Family Medicine
Dr. Jan Chlebowski, Graduate Education
Dr. Ron Clark, Internal Medicine
Dr. Ray Colello, Anatomy
Dr. Philippe Girerd, OB/GYN
Carol Hampton, Faculty and Instructional Development
Dr. Walter Lawrence, Surgery
Dr. Joyce Lloyd, Human Genetics
Dr. James Messmer, Undergraduate Medical Education
Dr. Mary Alice O’Donnell, Graduate Medical Education
Dr. Andrea Pozez, Surgery
Dr. Elizabeth Waterhouse, Neurology
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SOM Professionalism Website
http://www.medschool.vcu.edu/professionalism/
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