The Bridge Between Bioethics and Medical Practice: Medical Professionalism

Preface
Acknowledgments
Contents
Editors and Contributors
Part I Defining Medical Professionalism
1 Professionalism and Medical Practice—Introduction
	1.1 Introduction
	1.2 Basic Concepts
	1.3 History and Development
	1.4 Conceptual Clarification
	1.5 Ethical Dimension
		1.5.1 Excellence
		1.5.2 Accountability
		1.5.3 Altruism
		1.5.4 Humanism
	1.6 Conclusion
	References
2 Medical Professionalism—A Developmental View from the Trenches
	2.1 Introduction: Medical Professionalism: Perspectives and Expectations
		2.1.1 Medical Professionalism for the Professional
		2.1.2 Medical Professionalism for Patients and Caregivers
		2.1.3 Medical Professionalism for Third-Party Payers and Stakeholders
	2.2 The Need for Solid Roots of Medical Professionalism in the Medical Curriculum
	2.3 Medical Professionalism is at Stake When Most Needed
	2.4 The Impact of Continuous Changes
		2.4.1 Advancing Medical Knowledge
		2.4.2 Societal Laws and Attitudes
		2.4.3 Patients’ Changing Expectations
		2.4.4 Changing Clinical Settings
		2.4.5 Changing Resources Availability and Allocation
		2.4.6 New Clinical Scenarios
		2.4.7 Physicians’ Changing Duties, Roles, Responsibilities, Teamwork
	2.5 Medical Professionalism as a Continuously Changing Experience and Expertise
	2.6 Medical Professionalism as the Basis of Accountability
	2.7 How to Shape Medical Professionalism in Diverse Medical Jobs and Various Medical Duties
	2.8 How to Update Medical Professionalism During a Lifetime in Different Clinical Settings and Professional Roles
	2.9 Continuous Assessment of Medical Professionalism as an Essential Tool for Accountability and Continuous Improvement of the Patient-Physician Relationship
		2.9.1 How to Establish the Common and Solid Roots of Basic Knowledge of Medical Professionalism in the Medical Curriculum
		2.9.2 Teaching and Promoting the Peculiar Nature of the Contract with the Patient and the Society in Order to Foster Continuous Improvement of Medical Professionalism
	2.10 Conclusion
	References
3 The Need for a Common Set of Competencies as Components of a Medical Professionalism Construct, Paired with a Common Program of Assessment
	3.1 Introduction
	3.2 Psychometric Quality of Instruments Intended to Measure Medical Professionalism
	3.3 The Need to Achieve Consensus to Ensure a High Level of Medical Professionalism to Fulfill the Social Contract Between the Medical Profession and the Public
	3.4 A Methodological Proposal for an Accountability Assessment Program for Medical Professionalism
		3.4.1 Fidelity Assessments One and Two
		3.4.2 Statistical Models One and Two
	3.5 Conclusion
	References
Part II Medical Professionalism from Broader Perspectives
4 Medical Professionalism—Legal Framework
	4.1 Introduction
	4.2 International Legal Framework: From Right to Health to Medical Professional Ethics
	4.3 Medical Professionalism in the European Legal Framework: The Dominant Human Rights Perspective
	4.4 Responsive Regulation of Medical Profession
	4.5 Alternative Dispute Resolution and Medical Professionalism
	4.6 Medical Professionalism in the European Legal Framework: Quality and Safety of Medicinal Products for Human Use in the EU
	4.7 Physician Patient Relationship: Good Faith
	4.8 Professional Liability
	4.9 Setbacks
	4.10 Conclusion
	References
5 Medical Professionalism Sociological Framework
	5.1 Introduction
	5.2 Sociological Definition of the Concept of Profession
		5.2.1 Different Classical Sociological Approaches to Professions and Professionalism
		5.2.2 New Forms of Professions and Professionalism
	5.3 Determinants and Characteristics of Professions
	5.4 Professionalism and Professionality
	5.5 The Process of Professionalization
	5.6 The Medical Profession
		5.6.1 Authority and Autonomy of the Medical Profession
		5.6.2 Medicine and Society
		5.6.3 Fundamental Tensions Within the Medical Profession and Professionalism
		5.6.4 The Process of Medical Education and Socialization
		5.6.5 Professionalism in Medical Education
	5.7 Conclusion
	References
Part III The Moral Foundations of Medical Professionalism
6 Medical Professionalism—Philosophical Framework
	6.1 Introduction: The Nature of Medicine and Its Inherent Normativity
	6.2 Historical Account of Professionalism (as Ethics for or of Medicine) and Ethics in Medicine
		6.2.1 Hippocratic Ethics
		6.2.2 Unconscious Professionalism
		6.2.3 Bioethics as Ethics in Medicine
		6.2.4 Conscious Professionalism (or the Search for Ethics of and for Medicine)
	6.3 The Nature of Professionalism
	6.4 Medical Professionalism—Content and Forms
		6.4.1 Professionalism as a Shared Justificatory Structure (Inwardly/Withinwardly/Outwardly Oriented)
		6.4.2 Professionalism as an Organizing Principle
	6.5 Reflection, Mindfulness, and Phronesis (Professionalism’s “Watchwords”)
		6.5.1 Reflection
		6.5.2 Mindfulness
		6.5.3 Phronesis
	6.6 Conclusion
	References
7 Medical Professionalism from a Virtue Ethics Perspective
	7.1 Introduction
	7.2 Medical Professionalism According to E. Pellegrino
		7.2.1 The Healing Act of Medicine: The Role of the Physician as a Healer and Professional
		7.2.2 The Virtues in Medicine
	7.3 The Role of Virtues in Medical Practice Today
		7.3.1 The Role of Virtues in Medical Education
		7.3.2 Professional Identity Formation Based on Virtues
	7.4 Objections to a Virtue Based Model of Professionalism
	7.5 Final Remarks
	References
Part IV Medical Professionalism—Interpersonal Views and Considerations
8 Interpersonal or Relational Professionalism
	8.1 Introduction or Humans as Relational Beings
	8.2 Interpersonal or Relational Professionalism
		8.2.1 Interpersonal Professionalism—Categories of Relationships
	8.3 The Multiplicity, Multimodality, and Multiplexity of Relationships (or Intrapersonal Spheres)
	8.4 Guiding Principles and Tensions Within Relationships
	8.5 Party of Two Interrelated (or Interdependent) Agents
		8.5.1 Encounter
		8.5.2 Exchange
		8.5.3 Contract (or Covenant)
	8.6 A Party of Many Interrelated (or Interdependent) Agents
		8.6.1 Predictability and Certainty (“We” vs. “Them”)
		8.6.2 Functional Relationships (or Cooperation) (“We” as the First-Person Singular)
		8.6.3 Teamwork (We-Ness)
	8.7 Relationships as a Complex Mixture of Right and Wrong
	8.8 Multiple Frames of Reference
	8.9 Conclusion
	References
9 The Physician Patient Relationship: A Philosophical Perspective on Medical Professionalism and Virtues
	9.1 Introduction
	9.2 The Metamorphosis of Medical Ethics
	9.3 The Physician–Patient Relationship
		9.3.1 The Object of the Relation
		9.3.2 The Form of the Relation
	9.4 Conclusion
	References
10 Physicians Towards Colleagues and Vice Versa
	10.1 Introduction
	10.2 Becoming a Physician as Becoming a Part of a Specific Community
	10.3 Professional Relationships Between Equals (or Peer Relationships)—General Accounts
	10.4 Professional Relationships Between Physicians
		10.4.1 Professional Relationships Between Physicians—Theoretical Accounts
		10.4.2 Professional Relationships Between Physicians—Empirical Accounts
	10.5 Relationally Unprofessional Behaviors (or Breach of “Negative Duties”)
	10.6 The Professional Principle of Self-regulation
		10.6.1 Lapses in Professionalism (or Unprofessionalism)
		10.6.2 Causes of Unprofessionalism
		10.6.3 Self-regulation of Unprofessionalism
	10.7 Internal Hierarchies of the Medical Profession
	10.8 Positive Duties Towards Colleagues, or Hedgehog’s Dilemma of Physicians’ Professional Relationships
	10.9 Conclusion
	References
11 Physicians Towards Other Health Care Professionals and Vice Versa
	11.1 Introduction
	11.2 Driving Forces
	11.3 Interprofessionalism
		11.3.1 Interprofessionalism—Theoretical Accounts
		11.3.2 Interprofessionalism—Somewhat More Practical Accounts
		11.3.3 Interprofessionalism—Enacting and Constraining Practices
	11.4 Conflicts
	11.5 Inter Professionalism—Fulfilled and Failed Promises
	11.6 Status, Power, and Privilege: The Socio-Political World of Professionalism
		11.6.1 Complex Socio-Political World of Interprofessionalism
		11.6.2 Complex Socio-Political World of Health Care
	11.7 Workable and Viable (Inter)Professionalism Solutions
	11.8 Physicians’ Leadership—A Physician by Choice, a Businessman by Necessity
	11.9 Universal and Socially Immanent Ethics
	11.10 Conclusion
	References
12 Interdisciplinary Challenges to Inter Professional Practice
	12.1 Introduction
		12.1.1 Historical Notes
		12.1.2 Alleged Advantages and Challenges of IPP
	12.2 Conceptual Analysis
		12.2.1 Meaning of the Term “Interprofessional”
		12.2.2 Meaning of the Term Interdisciplinary
	12.3 Interprofessional Practice
		12.3.1 Historically Grown Power Struggles
		12.3.2 Should There Be a Captain Within the Health Care Team?
		12.3.3 How to Reach Consensus Within a Multiprofessional/Multidisciplinary Team
		12.3.4 Patient-Centered Care
	12.4 Recapitulation
	References
Part V Medical Professionalism—Unique Challenges and Duties
13 The Impact of Uncertainties on Physician’s Health and Wellbeing
	13.1 Introduction
	13.2 Core Uncertainties (Moral and Immoral Ones) and Its Effects
		13.2.1 Non-moral Uncertainties
		13.2.2 Moral Uncertainties
		13.2.3 Fundamental Moral Uncertainty or the Inherent Limits of Beneficence
		13.2.4 Moral Distress or Injury
	13.3 Accidental Uncertainties or Inhumane System of Noble Purposes (or Involvement as Greater Than Minimal Risk)
		13.3.1 Ill-Being At and From Work
		13.3.2 Burnout
		13.3.3 Vicious Circle of Professionals’ Ill-Being and Its Consequences
		13.3.4 Relief and A Way Forward
	13.4 Well-Being
	13.5 Conclusion
	References
14 Physicians and Organization: For a Reflective Organizational Professionalism
	14.1 Introduction
	14.2 Professionalism: A General Approach
	14.3 The Medical Professionalism in the New Millennium
	14.4 Organizational Professionalism and Medical Practice
		14.4.1 Patient Partnerships and Quality of Care
		14.4.2 Organizational Culture and Leadership
		14.4.3 Community Partnerships and Health Determinants
		14.4.4 Operations and Business Practices: For an Ethical Improvement
	14.5 Professionalism, Crisis and Decline of Institution Professional Identities
	14.6 A Reflective Professionalism
		14.6.1 Collective learning and institution of reflective practices
	14.7 Conclusion
	References
15 Victims or Actors? Can Professionalism Shape Physicians’ Roles Inside the Health Care System?
	15.1 Professionalism in the Era of the Economization of Health Care
	15.2 Physicians’ Identity and Position in Modern Healthcare Systems
	15.3 Modern “Performance” Metrics and Professionalism
	15.4 Physicians as Actors of Change in the Health Care System
	15.5 Physicians in Hybrid Roles
	15.6 The Roles and Responsibilities of Professional Organizations
	15.7 Health Care Delivery as a Complex Adaptive System
	15.8 Conclusion: Physicians as Victims or Actors—What is the Role of Professionalism in Improving Health Care Systems?
	References
16 What Do Doctors and Society Owe Each Other? A Scanlonian Reflection on Medical Professionalism
	16.1 Introduction: A Note on Professionalism
	16.2 T. M. Scanlon’s Contractualism
	16.3 Scanlon’s Contractualism and Medical Professionalism
		16.3.1 Prioritising Narrow and Broad Moralities
		16.3.2 Scope of Morality
	16.4 Problematic Professionalism
		16.4.1 Confidentiality and Problematic Public Reassurance
		16.4.2 Social Contracts and Conscientious Objection
		16.4.3 Physicians' Welfare and Society
		16.4.4 Doctors and ‘The Market’
	16.5 Conclusion
	References
17 Physicians Towards Society (And Vice Versa)
	17.1 Introduction
	17.2 Professions, Professionalization, Professionalism—A Very Brief Mapping of the Field
	17.3 Professionalism and Ethics
	17.4 Physicians’ “Out of Office” Duties as Mirrored in Professional Codes of Ethics
	17.5 Case Study 1: Unsolicited Medical Opinions
	17.6 Case Study 2: Physician-Assisted Suicide
	17.7 Case Study 3: Being a Physician in Pandemic Times
	17.8 Conclusions
	References
Part VI Medical Professionalism Across Contemporary and Cultural Landscapes
18 Professionalism and Medical Practice—Cultural Perspectives
	18.1 Introduction: Culture—Meaning, Understanding, and Faces
	18.2 General Differences Across Cultures
	18.3 Culture and Ethics
		18.3.1 Universality, or the Commonality of Bioethics
	18.4 Medicine and Professionalism as Culture
	18.5 Medical Professionalism Across Cultures
	18.6 Cultural Diversity
		18.6.1 Cultural Diversity—Theoretical Considerations
		18.6.2 Cultural Diversity—Practical Accounts (or “Interculturality”)
		18.6.3 Cultural Diversity—Practical Accounts (“Instrumentality”)
	18.7 Culture as a Means and End in Itself
	18.8 Conclusion
	References
19 Physicians as Citizens of the World
	19.1 Introduction
	19.2 Medicine as Global Professional Undertaking
	19.3 Physicians as Citizens
	19.4 Global Citizens
	19.5 Cosmopolitanism
	19.6 Global Consciousness and Ethics
	19.7 Medical Cosmopolitanism
	19.8 Conclusion
	References
20 Physicians as Agents in Evolving Knowledge Landscapes
	20.1 Introduction
	20.2 Person-Centered Care Within the Knowledge Landscapes
	20.3 Physician or the Patient—Who is the Decision Maker?
	20.4 Knowledge Landscapes on Health in a Digital Society
	20.5 The Asymmetry of the Physician–Patient Relationship
	20.6 Physicians as Creators of the Meaning
	20.7 Conclusion
	References
21 Afterthoughts: Towards a Realpolitik of Professionalism
	21.1 Introduction
	21.2 Educating for Professionalism?
	21.3 Professional Identity
	21.4 Beyond Idealism and the Clinical Coalface
	21.5 Conclusion
	References
Index