Professionalism, Nature or Nurture?

Patricia Lindholm, MD,
2010-2011 MMA President

Originally Posted January 6, 2011

I have been thinking about the concepts of collegiality and professionalism for a number of months. Trips to the dictionary have been unsatisfactory. After consulting a number of them, I found very limited definitions such as “belonging to a college, such as the college of cardinals in Rome” or being a member of a specific professional group.  In other words, there was no behavioral aspect to the definition of collegiality.  Perhaps like pornography, we “know it when we see it.”

Recently I read an excellent article in JAMA, “A Behavioral and Systems View of Professionalism,” by Cara Lesser et al that shed light on this issue.

The premise of the article is that professionalism is a set of competencies that can be taught and learned and that it must be practiced to be developed.  Also we are capable of improving upon professionalism as we continue in practice.

What is professionalism? According to Lesser, professionalism is not an inherent character trait or attitude.  Professionalism is defined as a set of behaviors.  It appears that collegiality - working collaboratively with other physicians and demonstrating respect for them all in the service of the patient – is one of those behaviors.

The article also demonstrated how external factors in the practice environment can affect professional behavior. Financial incentives such as pay for performance are not motivators to professional behavior.  Pride of purpose and intrinsic motivation are more important.  There are therefore two essential players in the service of professionalism: the individual interactions between doctor and patient and organizational management and governance. 

The good news of this research is that there are no hopeless cases.  All of us can learn the skills of professionalism and all of us can grow and refine our professional competencies throughout our careers.  This is one source of resiliency.  And resiliency is the preventive medicine and antidote for burnout. 
When our behaviors reflect our values we are whole people and much happier people.  We owe it to ourselves and to our patients to work to make the small and large health organizations more conducive to professional behavior and to eliminate perverse incentives in the system.