Physician Professionalism: Ethical and Moral Duties Physicians Encounter in the New Business Model of Medicine

Physician professionalism is the essence of being a doctor in our society. Physicians have a social agreement with society to act as a fiduciary in the patient–physician relationship. The introduction of managed medicine and the altered medical environment have disrupted that contract. The medical profession is being challenged by an eruption of technology, fluctuating market forces, and problems in the ever-changing landscape of healthcare delivery. These changes make it a real undertaking for physicians to meet their obligations to patients, forcing them to contend with political, legal, and market forces in order to meet their ethical responsibilities to their patients.

Professionalism is the basis of medicine’s social agreement with society. The contractual relationship between physicians and society demands that the interests of patients be placed above those of treating physicians. It also obliges physicians to set and maintain standards of competence and integrity and to provide knowledgeable and professional advice to society on matters of health and well-being. Physicians must act as a fiduciary to the patient, which means they must place the interests of their patients above all competing interests.

The medical profession is being challenged to meet its fiduciary responsibilities by erupting technology, fluctuating market forces, and evolving duties in the ever-changing healthcare delivery system. The exponential

transformations across an array of technology and market changes make it a real challenge for physicians to meet their obligations to patients. Indeed, the medical profession is confronted with political, legal, and market forces that challenge physicians to meet their fiduciary responsibility to their patients.

The fundamental principles inherent to physician professionalism include patient welfare, patient autonomy, and elimination of discrimination in healthcare, whether based on race, gender, socioeconomic status, ethnicity, or religion. Market forces, societal pressures, and administrative exigencies must not compromise the principles inherent in a true physician–patient relationship.

Physicians must be sincere and trustworthy with patients and empower them to make informed decisions about their treatment options. Patients’ decisions about their medical care must be paramount, as long as it is ethical for the physician to comply with those decisions, and they do not lead to demands for care that is not appropriate given the clinical presentation.

This article describes physicians’ obligatory professional responsibilities, their medical and legal fiduciary obligations, and how employed physicians tangled in a web of ascendant market fundamentalism may be caught between the responsibility to maintain patient primacy and their own professional responsibilities

PROFESSIONAL RESPONSIBILITIES

The physician’s professional responsibilities encompass all of the following:

A Commitment to Professional Competence Through Lifelong Learning

Education is crucial in the world of constantly advancing medical knowledge. Physicians must be devoted to lifelong learning and maintaining the knowledge and skills they need to provide standard-of-care medicine. Appropriate mechanisms must be in place for all physicians to achieve this goal. All physicians should pursue the opportunity for continuing medical education services to maintain the highest level of competence in their area of practice.

Integrity in Dealing with Patients

Medical ethics, common law, and, in many states, codified statutory law mandate the informed consent process. Beyond the ethical and legal reasons for informed consent practices, medical informed consent is essential to a true patient–physician partnership. Physicians must participate in the informed consent process so patients and their families can share in the decision-making process. Whenever patients are injured as a result of medical care, they should be informed immediately because failure to inform patients and families compromises patient and societal trust and confidence in the medical profession. Reporting and analyzing medical errors provides a foundation for developing prevention and improvement strategies and equitable compensation to injured parties. Reporting medical errors and injuries is an integral component of informed consent.

Respect for Patient Confidentiality

Safeguarding patient confidentiality is imperative in today’s world, where electronic information systems are used to compile and store patient information and data, and where the use of genomic information may affect a patient’s ability to obtain insurance and career opportunities. The sanctity of the patient’s medical information must be safeguarded. This issue of patient confidentiality is especially likely to arise when providing information to persons acting on a patient’s behalf because the patient is not mentally competent to consent. All physician conversations must be measured and well thought through; the commitment to confidentiality occasionally may be trumped by overarching considerations of public interest.

Preservation of the Physician–Patient Relationship

Illness can cause patients to emotionally regress and become dependent on an authority figure. Given the patient’s intrinsic vulnerability and the dependency that may arise, physicians must never exploit a patient sexually or for personal financial gain.

Continuous Improvement of Healthcare Delivery

Physicians must be dedicated to continuous improvement in the quality of healthcare they provide. This commitment must involve not only maintaining personal clinical competence, but also working collaboratively with colleagues to increase clinical knowledge, reduce medical errors, increase patient safety, minimize overuse and misuse of healthcare resources, and optimize patient outcomes.

Physicians, individually and through professional organizations, must take the responsibility for ensuring the availability of uniform and excellent standard-of-care medicine across all demographics and socioeconomic classes.

Just Distribution of Finite Medical Resources

Physicians must provide healthcare that is based on judicious and cost-effective management of limited clinical resources and healthcare dollars. The physician’s professional responsibility for equitable allocation of resources requires conscientious avoidance of tests and procedures that are unnecessary and financially driven. Providing unwarranted medical services exposes patients to risk and expense and limits the available resources for others in true need of those resources. Physicians and organizations—both “for profit” and nonprofit—should never compromise their professional responsibilities by pursuing personal advantage.

Physicians have a duty to disclose conflicts of interest that arise in their professional work. They also have a moral and ethical duty to disclose unethical behavior of physicians, organizations, and physicians and organizations acting in concert. Physicians as a profession must participate in self-regulation, including remediation and punishment of physicians, administrators, and organizations that fail to meet professional standards.

Excerpted from Physicians and the Law: The Intersection of Medicine, Business, and Medical Malpractice by Timothy E. Paterick, MD, JD, MBA

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