I thought you’d like to hear from a national guru in professionalism, Dr. Hendry Ton, Health Sciences Associate Clinical Professor, Department of Psychiatry and Behavioral Science. These few years we’ve worked together, I’ve been so impressed with Dr. Ton. He’s taught me so much, and he’s an all around nice guy.
In the words of Dr. Ton:
It has been nearly two decades, but I vividly remember my first formative experiences as a medical student. It was in Human Anatomy as my classmates and I huddled around our cadaver. Our instructor gently fingered the coarse stitching that laced along the middle of the cadaver’s chest and declared, “Something important is waiting for you in there.”
Over the next months, my partners and I studied his body in detail, discovering things about him that he likely never knew about himself. Then came time to undo the stitches in his chest. We proceeded to uncover his heart with anticipation. What was waiting for us in there? Then we saw what our instructor had alluded to–evidence of an aborted coronary bypass surgery. Coagulated blood covered his chest wall, and blood vessels that seemed out of place were stitched to his heart. These were the signs of the last moments of his life. Our instructor confirmed that he had died on the operating table.
I was taken back in time. I imagined what it must have been like for him to speak with his family before the operation. Maybe he reassured them that he would be okay, or perhaps confided in them about his fears of dying. I marveled at the trust and hope that he must have placed with his physicians and nurses as he drifted off to unconsciousness in the OR. I empathized with what it must have been like for his doctors who held his heart in their hands it struggled with its last beats. And I was humbled that despite everything that must have been going on with him, he had thought about his future students and trusted us with his body. He was my first patient and medical teacher.
My experience with him highlights the incredible privileges that society has entrusted to us as health care providers. Few others are allowed so many opportunities to touch the deep and dark parts of the human experience, to celebrate a new life brought into the world, or to attend to the passing of an existing one. We must use these privileges responsibility in the interest of our patients and the public to promote healing and alleviate suffering. Professionalism represents this commitment.
At UC Davis, we have embarked on an effort to develop a professionalism curriculum that spans the four years of medical student education. In a collaborative of faculty, staff, residents, and medical students, we have redefined the professionalism graduation competency and mapped out milestones across the four years that will serve as anchor points for our curriculum. Central to this is the idea that developing professionalism involves not just adhering to a set of acceptable behaviors, but also developing altruism, humanism and ethical understanding, improving the ability to manage conflicting professional responsibilities and interests, and enhancing self reflection and communication skills. Professionalism is quality improvement. Professionalism lapses are similar to other forms of medical errors, in that they happen more often than we know, that they range from being inconsequential to being life threatening, that systems and personal issues may contribute to them, and that good doctors can have professionalism lapses.
Recently, I had dinner with a primary care physician who talked about the challenge that she and her colleagues experience when trying to provide mental health care in rural settings. In her system, PCPs cannot be reimbursed for treating mental health diagnoses such as major depressive disorder, whereas they would if they diagnosed the patient with nonspecific insomnia or somatic problems. Does the physician treat the depression despite not being reimbursed? Or should she falsify the diagnosis to get reimbursed? And what is the overall impact of this issue on their ability to address emotional suffering?
The nature of our work, our responsibilities, and the systems within which we operate generate professionalism dilemmas everyday. Some are easily addressed, but many are not. By equipping ourselves with the skills, knowledge, and attitudes necessary to understand and maintain professionalism in the context of an increasingly complex health care system, we honor the privileges and responsibilities with which our patients and society entrust us.
- Hendry Ton, M.D., M.S., Health Sciences Associate Clinical Professor
Director, SOM Cultural Competency and Professionalism
Psychiatry Clerkship Director
Medical Director, Transcultural Wellness Center
Director of Education, Center for Reducing Health Disparities
Department of Psychiatry and Behavioral Science
UC Davis Health System