Chapter 196: Professionalism and Licensure

INTRODUCTION

Professionalism is an essential characteristic of every anesthesiologist. The American Board of Anesthesiology places a high value on professionalism. In fact, a resident deemed deficient in professionalism must receive an unsatisfactory semiannual evaluation—despite satisfactorily meeting the requirements of the other core competencies.

DEFINING PROFESSIONALISM

Professionalism is a difficult competency to measure, particularly when the physician has neither success nor failure in this area. All types of physicians should adhere to the four basic components of professionalism:

1. Ethics—Physicians should demonstrate the highest standards of moral behavior. They should have integrity, character, and honesty.

2. Accountability—Physicians should always place the needs of the patient over their self-interest. They should be committed to providing excellent clinical care, a strong sense of duty, and altruism.

3. Humanism—Humanism underlies the successful physician–patient relationship. An understanding of diversity is essential for having tolerance and respect for all human beings. Physicians should demonstrate compassion, dependability, and collegiality.

4. Physician Well-Being—Throughout their careers, physicians should not forget the importance of their own physical and mental health, as well as that of their colleagues. They should be aware of issues like substance abuse and depression, both of which could lead to physician impairment.

For most physicians, professionalism comes naturally. Failure to act professional, whether in residency training or in practice, can occur for many reasons, such as:

• Abuse of authority

• Lack of patient confidentiality

• Egotism

• Dishonesty

• Impairment

• Poor work ethic

• Conflict of interest

• Wasting of resources

• Fraud (research, billing)

THE PROFESSIONALISM CORE COMPETENCY

As defined by the American Council on Graduate Medical Education, every resident training to be anesthesiologist should:

• demonstrate integrity and ethical behavior

• accept responsibility and follow through on tasks

• admit mistakes

• put patient needs above own interests

• recognize and address ethical dilemmas and conflicts of interest

• maintain patient confidentiality

• be industrious and dependable

• complete tasks carefully and thoroughly

• respond to requests in a helpful and prompt manner

• practice within the scope of his/her abilities

• recognize limits of his/her abilities and ask for help when needed

• refer patients when appropriate

• exercise authority accorded by position and/or experience

• demonstrate care and concern for patients and their families regardless of age, gender, ethnicity, or sexual orientation

• respond to each patient’s unique characteristics and needs

PROFESSIONALISM IN ANESTHESIOLOGY

Interaction with Patients

As consultants to surgeons, anesthesiologists have brief relationships with their patients. Professionalism in the preoperative period includes thorough knowledge of the patient’s medical history, ideally prior to meeting the patient for the first time. The anesthesiologist should assess and allay the patient’s anxiety while at the same time obtain informed consent. In the operating room, the anesthesiologist should always attend to the patient, not the monitors. He/she should respect the patient’s autonomy and dignity, and maintain strict patient ...