Medical Professionalism in the New Millennium: A Physician Charter
2002; American College of Physicians; Volume: 136; Issue: 3 Linguagem: Inglês
10.7326/0003-4819-136-3-200202050-00012
ISSN1539-3704
Tópico(s)Innovations in Medical Education
ResumoPerspectives5 February 2002Medical Professionalism in the New Millennium: A Physician CharterFREEProject of the ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine*Project of the ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-136-3-200202050-00012 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail To our readers: I write briefly to introduce the Medical Professionalism Project and its principal product, the Charter on Medical Professionalism. The charter appears in print for the first time in this issue of Annals and simultaneously in The Lancet. I hope that we will look back upon its publication as a watershed event in medicine. Everyone who is involved with health care should read the charter and ponder its meaning.The charter is the product of several years of work by leaders in the ABIM Foundation, the ACP–ASIM Foundation, and the European Federation of Internal Medicine. The charter consists of a brief introduction and rationale, three principles, and 10 commitments. The introduction contains the following premise: Changes in the health care delivery systems in countries throughout the industrialized world threaten the values of professionalism. The document conveys this message with chilling brevity. The authors apparently feel no need to defend this premise, perhaps because they believe that it is a universally held truth. The authors go further, stating that the conditions of medical practice are tempting physicians to abandon their commitment to the primacy of patient welfare. These are very strong words. Whether they are strictly true for the profession as a whole is almost beside the point. Each physician must decide if the circumstances of practice are threatening his or her adherence to the values that the medical profession has held dear for many millennia.Three Fundamental Principles set the stage for the heart of the charter, a set of commitments. One of the three principles, the principle of primacy of patient welfare, dates from ancient times. Another, the principle of patient autonomy, has a more recent history. Only in the later part of the past century have people begun to view the physician as an advisor, often one of many, to an autonomous patient. According to this view, the center of patient care is not in the physician's office or the hospital. It is where people live their lives, in the home and the workplace. There, patients make the daily choices that determine their health. The principle of social justice is the last of the three principles. It calls upon the profession to promote a fair distribution of health care resources.There is reason to expect that physicians from every point on the globe will read the charter. Does this document represent the traditions of medicine in cultures other than those in the West, where the authors of the charter have practiced medicine? We hope that readers everywhere will engage in dialogue about the charter, and we offer our pages as a place for that dialogue to take place. If the traditions of medical practice throughout the world are not congruent with one another, at least we may make progress toward understanding how physicians in different cultures understand their commitments to patients and the public.Many physicians will recognize in the principles and commitments of the charter the ethical underpinning of their professional relationships, individually with their patients and collectively with the public. For them, the challenge will be to live by these precepts and to resist efforts to impose a corporate mentality on a profession of service to others. Forces that are largely beyond our control have brought us to circumstances that require a restatement of professional responsibility. The responsibility for acting on these principles and commitments lies squarely on our shoulders.–Harold C. Sox, MD, EditorPhysicians today are experiencing frustration as changes in the health care delivery systems in virtually all industrialized countries threaten the very nature and values of medical professionalism. Meetings among the European Federation of Internal Medicine, the American College of Physicians–American Society of Internal Medicine (ACP–ASIM), and the American Board of Internal Medicine (ABIM) have confirmed that physician views on professionalism are similar in quite diverse systems of health care delivery. We share the view that medicine's commitment to the patient is being challenged by external forces of change within our societies.Recently, voices from many countries have begun calling for a renewed sense of professionalism, one that is activist in reforming health care systems. Responding to this challenge, the European Federation of Internal Medicine, the ACP–ASIM Foundation, and the ABIM Foundation combined efforts to launch the Medical Professionalism Project (www.professionalism.org) in late 1999. These three organizations designated members to develop a “charter” to encompass a set of principles to which all medical professionals can and should aspire. The charter supports physicians' efforts to ensure that the health care systems and the physicians working within them remain committed both to patient welfare and to the basic tenets of social justice. Moreover, the charter is intended to be applicable to different cultures and political systems.PreambleProfessionalism 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.At present, the medical profession is confronted by an explosion of technology, changing market forces, problems in health care delivery, bioterrorism, and globalization. As a result, physicians find it increasingly difficult to meet their responsibilities to patients and society. In these circumstances, reaffirming the fundamental and universal principles and values of medical professionalism, which remain ideals to be pursued by all physicians, becomes all the more important.The medical profession everywhere is embedded in diverse cultures and national traditions, but its members share the role of healer, which has roots extending back to Hippocrates. Indeed, the medical profession must contend with complicated political, legal, and market forces. Moreover, there are wide variations in medical delivery and practice through which any general principles may be expressed in both complex and subtle ways. Despite these differences, common themes emerge and form the basis of this charter in the form of three fundamental principles and as a set of definitive professional responsibilities.Fundamental PrinciplesPrinciple of primacy of patient welfare. This principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician–patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle.Principle of patient autonomy. Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients' decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.Principle of social justice. The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.A Set of Professional ResponsibilitiesCommitment to professional competence. Physicians must be committed to lifelong learning and be responsible for maintaining the medical knowledge and clinical and team skills necessary for the provision of quality care. More broadly, the profession as a whole must strive to see that all of its members are competent and must ensure that appropriate mechanisms are available for physicians to accomplish this goal.Commitment to honesty with patients. Physicians must ensure that patients are completely and honestly informed before the patient has consented to treatment and after treatment has occurred. This expectation does not mean that patients should be involved in every minute decision about medical care; rather, they must be empowered to decide on the course of therapy. Physicians should also acknowledge that in health care, medical errors that injure patients do sometimes occur. Whenever patients are injured as a consequence of medical care, patients should be informed promptly because failure to do so seriously compromises patient and societal trust. Reporting and analyzing medical mistakes provide the basis for appropriate prevention and improvement strategies and for appropriate compensation to injured parties.Commitment to patient confidentiality. Earning the trust and confidence of patients requires that appropriate confidentiality safeguards be applied to disclosure of patient information. This commitment extends to discussions with persons acting on a patient's behalf when obtaining the patient's own consent is not feasible. Fulfilling the commitment to confidentiality is more pressing now than ever before, given the widespread use of electronic information systems for compiling patient data and an increasing availability of genetic information. Physicians recognize, however, that their commitment to patient confidentiality must occasionally yield to overriding considerations in the public interest (for example, when patients endanger others).Commitment to maintaining appropriate relations with patients. Given the inherent vulnerability and dependency of patients, certain relationships between physicians and patients must be avoided. In particular, physicians should never exploit patients for any sexual advantage, personal financial gain, or other private purpose.Commitment to improving quality of care. Physicians must be dedicated to continuous improvement in the quality of health care. This commitment entails not only maintaining clinical competence but also working collaboratively with other professionals to reduce medical error, increase patient safety, minimize overuse of health care resources, and optimize the outcomes of care. Physicians must actively participate in the development of better measures of quality of care and the application of quality measures to assess routinely the performance of all individuals, institutions, and systems responsible for health care delivery. Physicians, both individually and through their professional associations, must take responsibility for assisting in the creation and implementation of mechanisms designed to encourage continuous improvement in the quality of care.Commitment to improving access to care. Medical professionalism demands that the objective of all health care systems be the availability of a uniform and adequate standard of care. Physicians must individually and collectively strive to reduce barriers to equitable health care. Within each system, the physician should work to eliminate barriers to access based on education, laws, finances, geography, and social discrimination. A commitment to equity entails the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician, without concern for the self-interest of the physician or the profession.Commitment to a just distribution of finite resources. While meeting the needs of individual patients, physicians are required to provide health care that is based on the wise and cost-effective management of limited clinical resources. They should be committed to working with other physicians, hospitals, and payers to develop guidelines for cost-effective care. The physician's professional responsibility for appropriate allocation of resources requires scrupulous avoidance of superfluous tests and procedures. The provision of unnecessary services not only exposes one's patients to avoidable harm and expense but also diminishes the resources available for others.Commitment to scientific knowledge. Much of medicine's contract with society is based on the integrity and appropriate use of scientific knowledge and technology. Physicians have a duty to uphold scientific standards, to promote research, and to create new knowledge and ensure its appropriate use. The profession is responsible for the integrity of this knowledge, which is based on scientific evidence and physician experience.Commitment to maintaining trust by managing conflicts of interest. Medical professionals and their organizations have many opportunities to compromise their professional responsibilities by pursuing private gain or personal advantage. Such compromises are especially threatening in the pursuit of personal or organizational interactions with for-profit industries, including medical equipment manufacturers, insurance companies, and pharmaceutical firms. Physicians have an obligation to recognize, disclose to the general public, and deal with conflicts of interest that arise in the course of their professional duties and activities. Relationships between industry and opinion leaders should be disclosed, especially when the latter determine the criteria for conducting and reporting clinical trials, writing editorials or therapeutic guidelines, or serving as editors of scientific journals.Commitment to professional responsibilities. As members of a profession, physicians are expected to work collaboratively to maximize patient care, be respectful of one another, and participate in the processes of self-regulation, including remediation and discipline of members who have failed to meet professional standards. The profession should also define and organize the educational and standard-setting process for current and future members. Physicians have both individual and collective obligations to participate in these processes. These obligations include engaging in internal assessment and accepting external scrutiny of all aspects of their professional performance.SummaryThe practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies. These challenges center on increasing disparities among the legitimate needs of patients, the available resources to meet those needs, the increasing dependence on market forces to transform health care systems, and the temptation for physicians to forsake their traditional commitment to the primacy of patients' interests. To maintain the fidelity of medicine's social contract during this turbulent time, we believe that physicians must reaffirm their active dedication to the principles of professionalism, which entails not only their personal commitment to the welfare of their patients but also collective efforts to improve the health care system for the welfare of society. This Charter on Medical Professionalism is intended to encourage such dedication and to promote an action agenda for the profession of medicine that is universal in scope and purpose. Comments0 CommentsSign In to Submit A Comment Dr.Tanu Pramanik PhD(Social Psychology) Principal,Dr.Jogenananda Pramanik MD Executive Dean, Careers Abroad Institute School of Medicine, Mandeville, Jamaica.WI. Principal, Careers Abroad Institute School of Medicine,Hatfield, Mandeville, Manchester, Jamaica, WI.,16 October 2017 Humanise health care- A major concern workdwide The practice of medicine in the modern era is beset with unprecedented challenges in virtually all cultures and societies(1).We applauded current initiative to review and humanise health care.In the recent past,we responded to the editorial in British Medical Journal, emphasising impact of behavioural science curriculum in medical education.We are painfully concerned that most of our medical students are unfortunate that they did not get an opportunity to learn about behavioural science as a part of their curriculum during their medical school training program. They were never been exposed to the local community for a supervised health screening program with a mission to develop doctor-patient relationship and professional communication skills in real life scenarioRef: 1.Medical Professionalism in the New Millennium: A Physician Charter.Impact of behavioural science curriculum in medical education 2016; 355 doi: https://doi.org/10.1136/bmj.i6262 (Published 13 December 2016)Cite this as: BMJ 2016;355:i6262Re: Humanising healthcare Author, Article, and Disclosure InformationAffiliations: Corresponding Author: Linda Blank, ABIM Foundation, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106-3699; e-mail, [email protected]org.*This charter was written by the members of the Medical Professionalism Project: ABIM Foundation: Troy Brennan, MD, JD (Project Chair), Brigham and Women's Hospital, Boston, Massachusetts; Linda Blank (Project Staff), ABIM Foundation, Philadelphia, Pennsylvania; Jordan Cohen, MD, Association of American Medical Colleges, Washington, DC; Harry Kimball, MD, American Board of Internal Medicine, Philadelphia, Pennsylvania; and Neil Smelser, PhD, University of California, Berkeley, California. ACP–ASIM Foundation: Robert Copeland, MD, Southern Cardiopulmonary Associates, LaGrange, Georgia; Risa Lavizzo-Mourey, MD, MBA, Robert Wood Johnson Foundation, Princeton, New Jersey; and Walter McDonald, MD, American College of Physicians–American Society of Internal Medicine, Philadelphia, Pennsylvania. European Federation of Internal Medicine: Gunilla Brenning, MD, University Hospital, Uppsala, Sweden; Christopher Davidson, MD, FRCP, FESC, Royal Sussex County Hospital, Brighton, United Kingdom; Philippe Jaeger, MB, MD, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; Alberto Malliani, MD, Università di Milano, Milan, Italy; Hein Muller, MD, PhD, Ziekenhuis Gooi-Noord, Rijksstraatweg, the Netherlands; Daniel Sereni, MD, Hôpital Saint-Louis, Paris, France; and Eugene Sutorius, JD, Faculteit der Rechts Geleerdheid, Amsterdam, the Netherlands. Special Consultants: Richard Cruess, MD, and Sylvia Cruess, MD, McGill University, Montreal, Canada; and Jaime Merino, MD, Universidad Miguel Hernández, San Juan de Alicante, Spain. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCharter on Medical Professionalism: Putting the Charter into Practice Sadeq A. Quraishi and Ayesha N. Khalid Charter on Medical Professionalism: Putting the Charter into Practice Neil J. Smelser Charter on Medical Professionalism: Putting the Charter into Practice Charles M. Haskell Charter on Medical Professionalism: Putting the Charter into Practice Neil J. Smelser Charter on Medical Professionalism: Putting the Charter into Practice Donatella Lippi , GianFranco Gensini , and Andrea A. Conti Charter on Medical Professionalism: Putting the Charter into Practice Neil J. Smelser Charter on Medical Professionalism: Putting the Charter into Practice Jerome C. Arnett Jr. Charter on Medical Professionalism: Putting the Charter into Practice Sylvia L. Cruess and Richard L. Cruess Charter on Medical Professionalism: Putting the Charter into Practice Robert Feldman Charter on Medical Professionalism: Putting the Charter into Practice Walter J. McDonald Charter on Medical Professionalism: Putting the Charter into Practice Steven A. Wartman Charter on Medical Professionalism: Putting the Charter into Practice Jordan J. Cohen Charter on Medical Professionalism: Putting the Charter into Practice Yevgeniya Nusinovich Charter on Medical Professionalism: Putting the Charter into Practice Risa Lavizzo-Mourey Charter on Medical Professionalism: Putting the Charter into Practice Richard L. Cruess and Sylvia L. Cruess Charter on Medical Professionalism: Putting the Charter into Practice Christopher J. Lyons Professionalism and the Medical Student Nancy R. Angoff Providing High-Value, Cost-Conscious Care Christine K. Cassel Providing High-Value, Cost-Conscious Care Steven E. Weinberger Can the Practice of Retainer Medicine Improve Primary Care? Martin T. Donohoe Metrics Cited byA scoping review on the relationship between mental wellbeing and medical professionalismEmergency physician professionalism versus wellness: A conceptual modelSystem Citizenship: Re-Envisioning the Physician Role as Part of the Sixth Wave of ProfessionalismRECALMIN IV. Evolución de la actividad de las unidades de medicina interna del Sistema Nacional de Salud (2008-2021)RECALMIN IV. Evolution in the activity of internal medicine units of the National Health System (2008–2021)Should a patient’s socioeconomic status count in decisions about treatment in medical care? A longitudinal study of Norwegian doctorsValidity and reliability of the Professionalism Assessment Scale in Turkish medical studentsRelevance of Bone Marrow Biopsies for Response Assessment in US National Cancer Institute National Clinical Trials Network Follicular Lymphoma Clinical Trials“It really puts me in a bind”, professionalism dilemmas reported by Chinese residentsShared Decision MakingLos fundamentos del profesionalismo en medicinaImplementation of an Online Reporting System to Identify Unprofessional Behaviors and Mistreatment Directed at Trainees at an Academic Medical CenterNational Health Policy Leadership Program for General InternistsProfessionalism in dentistry: deconstructing common terminologyMedical students’ participation in the Volunteering Program during the COVID-19 pandemic: a qualitative study about motivation and the development of new competenciesTranslating and validating a Japanese version of the instrument for patient assessment of medical professionalism (J-IPAMP): a cross-sectional surveyBuilding organisations, setting minds: exploring how boards of Dutch medical specialist companies address physicians’ professional performanceYou are exactly my type! The traits of a good doctor: a factor analysis study on public's perspectivesProfessionalism in built environment research: beyond integrity and good practiceA curriculum focused on informed empathy improves attitudes toward persons with disabilitiesWhy Not Jump out of Decision-Making Capacity?Obligation or getaway? A qualitative inquiry into medical professionalism under COVID-19 among medical students and new physicians in a Taiwan hospitalImplementation of a self-determination based clinical program to reduce cardiovascular disease riskRethinking professional identity formation amidst protests and social upheaval: a journey in AfricaThe Impact of the COVID-19 Pandemic on Medical Students' Attitudes of Professionalism: A Web Based Cross-Sectional StudyASHP Statement on ProfessionalismA Scoping Review on the Concept of Physician CaringPerson-centred care in psychiatry: a clinical and philosophically informed approachTıpta Profesyonelizm ve Tıp Eğitimine EntegrasyonuRethinking Professionalism Assessments in Medical EducationRachel Mintz, BS, Leah Pierson, BA, and David Gibbes Miller, MScThe disruptive radiologistContinuing Medical Education of Scientific Societies in Spain: Analysis of current situation and proposals for the futureLa Formación Médica Continuada de las Sociedades Científicas en España: análisis de la situación actual y propuestas de futuroWhy Physician Virtue Is Critical to the Survival of RadiologyYou Can’t Have AI Both Ways: Balancing Health Data Privacy and Access FairlyFEEDBACK OF THE SESSION ON PROFESSIONALISM AND ETHICS USING VARIOUS TEACHING METHODS AMONG UNDERGRADUATE MEDICAL STUDENTSBackground factors associated with academic motivation for attending medical school immediately after admission in Japan: A single‐center studyRapprochement and Reform: Overcoming Factionalism in Policy Making for Serious Mental IllnessThe identity of the internist: A U.S. perspectiveProfessionalism: COVID-19 made me do it!Climate change and the different roles of physicians: a critical response to "A Planetary Health Pledge for Health Professionals in the Anthropocene"Professionalism, Organizationalism and Sur-moralism: Three ethical systems for physiciansWe Have No Choice but to Transform: The Future of Medical Education After the COVID-19 PandemicAwareness and Perceptions among Members of a Japanese Cancer Patient Advocacy Group Concerning the Financial Relationships between the Pharmaceutical Industry and PhysiciansAccess-to-Care and Conscience: Conflicting or Coherent?Assisted Living Administrators’ Approaches to Advance Care PlanningGreat expectations: views and perceptions of professionalism amongst mental health services staff, patients and carersIntroductionAn Ethical Discussion of (Un-)Certainty at the End of Life: Exemplification by Means of Continuous Deep Sedation and Advance DirectivesWhy Me? – The Concept of Physicians’ Spiritual Self-Care: A Contribution to Professional and Organisational EthicsPharmaceutical Company Payments to Clinical Practice Guideline AuthorsTeaching and Evaluating ProfessionalismProfessionalism and Medical Practice—IntroductionWhat Do Doctors and Society Owe Each Other? A Scanlonian Reflection on Medical ProfessionalismPhysicians Towards Society (And Vice Versa)Medical Professionalism—Legal FrameworkTeaching Quality, Safety, and ProfessionalismDie ethische Aufsicht über die Datenwissenschaft im GesundheitswesenThis is Our Lane: A Pilot Study Examining the Surgeon's Role in Social Justice AdvocacyReflective Essays During Clerkship Following a Pre-clerkship Leadership CurriculumUS Physicians’ Knowledge About The Americans With Disabilities Act And Accommodation Of Patients With DisabilitySentidos e significados de profissionalismo médico para residentes de ginecologia e obstetríciaSenses and meanings of medical professionalism for gynecology and obstetrics residentsPercepção de preceptores do internato sobre a influência de modelos na formação médicaPerceptions of the CanMEDS Competencies of Faculty and Students in Different Curriculum Systems of a Medical School in ChinaGeneral Medicine Departments of Japanese Universities Contribute to Medical Education in Clinical Settings: A Descriptive Questionnaire StudyMedical Professionalism in the Provision of Clinical Care in Healthcare OrganizationsMachiavellian Medical Students Report More Academic Misconduct: A Cocktail Fuelled by Psychological and Contextual FactorsDefining Potentially Unprofessional Behavior on Social Media for Health Care Professionals: Mixed Methods StudyPractices and Attitudes of Bavarian Stakeholders Regarding the Secondary Use of Health Data for Research Purposes During the COVID-19 Pandemic: Qualitative Interview StudyWhen patient-centred and family-centred approaches clash: Taiwanese health professions students' patient autonomy dilemmasScreenplays and Screenwriting as an Innovative Teaching Tool in Medical Ethics EducationDocs and Cops: Origins and Ongoing Challenges of Evidence-Based PolicingThe mediating role of social support in the relationship between physician burnout and professionalism behaviorsQualitative Content Analysis of Coworkers’ Safety Reports of Unprofessional Behavior by Physicians and Advanced Practice ProfessionalsGeriatric Choosing Wisely choice of recommendations in France: a pragmatic approach based on clinical auditsThe role of undergraduate medical students training in respect for patient confidentialityTranslating and validating a Japanese version of the Patient Care Ownership Scale: a multicenter cross-sectional studyDevelopment and validation of scale for measuring attitudes towards e-professionalism among medical and dental students: SMePROF-S scaleSelf-compassion in medical students: a pilot study of its association with professionalism pressureHow doctors are betraying the Hippocratic oathAn Evidence Review of Low-Value Care Recommendations: Inconsistency and Lack of Economic Evidence ConsideredA Health Systems Ethical Framework for De-implementation in Health CareDeveloping a Competency Framework of Interprofessional Occupational Health TeamAmerican Medical Society for Sports Medicine Position Statement: Principles for the Responsible Use of Regenerative Medicine in Sports MedicinePerception of Medical Professionalism among Medical Residents in SpainDevelopment of a taxonomy of unprofessional behavior in clinical learning environments using learner-generated critical incidentsReflections on State Medical Board Visits as a Tool for Multi-Level Teaching of Professionalism in Medical EducationThe care needs of persons with oropharyngeal dysphagia and their informal caregivers: A scoping reviewAmerican Academy of Neurology Code of Professional ConductMedical professionalism research characteristics and hotspots: a 10-year bibliometric analysis of publications from 2010 to 2019Artist’s Statement: Moral InjuryIdentifying distinctive traits of healthcare leaders in Israel: in-depth interviews with senior physicians – an exploratory studyThe Importance of Including Abortion in Undergraduate Medical EducationPhysician Use of Stigmatizing Language in Patient Medical Records‘I found myself a despicable being!’: Medical students face disturbing moral dilemmas2020 American Heart Association and American College of Cardiology Consensus Conference on Professionalism
Referência(s)