Extending medical professionalism

While it is tempting to extend the obligations of a contemporary medical professional there may be inadvertent consequences in the real world. ¹ The RCP definition of professionalism of 2005 focused on public trust as the major issue. ² This has always felt rather lacking in principle and inspiration, not least because the public attitude could be read as the sole arbiter of professional attributes. More important is that both the public acceptance and duties of the profession are expressed through the surrogacy of the media and Government/NHS organizations, which have economic and social conflicts of interest to declare. An extension from individual to population issues, as subsequently negotiated with CMOs, or when ‘Quality Improvement’ becomes involved, compounds those conflicts. This rather abstract reality is set to become more parochial as Trusts and Consortia compete to sustain their business models and economic viability in a more granular NHS. The progressive embedding of the profession in the NHS over six decades makes it difficult to examine how far desirable medical attributes are matters of an employment contract as well as an abstract professionalism.

The recently reported official approach to ‘disruptive’ behaviour suggests where the confusion of such categories may lead. ³ A plausible preoccupation with ‘safety’ is used to assert a stance of ‘zero tolerance’. However, the criteria of disruption have always been subject to context and opinion. When clinicians resist local management decisions for professional reasons in future what label will that earn if employment and professional standards are viewed as identical? Those colleagues known as whistleblowers visited such conflicts even in the less competitive years of the NHS. Professional identity appears vulnerable to manipulation in a climate of business interests, ambivalent professional associations and semi-prescriptive formal authorities. Are all the universals that professionals owe to Apollo truly owed to Caesar?