Professionalism

It’s a funny word.

A word that is completely drilled into us over and over at medical school. Even before we get here we are told that from now on we must behave in a professional manner, not do anything that could compromise our fitness to practice and stay on the straight and narrow.

Yet there isn’t actually an accepted definition.

It’s a very difficult word to define because it means different things to different people and relies heavily on context.

I generally judge professionalism by looking back on things that I or others have done and to think if there was a way to do that that would have respected the dignity of the patient more, that would have been less painful for the patient or that would have been easier on my colleagues?

But still it’s hard to know if I’m hitting at the right ball park. For example last week when I was on my HCA shift – this is a thing that the medical school are making us do at the weekends now, it’s an annoying amount of time to lose from studying and other stuff that I want to be doing but I think I’m learning, though how relevant that learning is, is another matter.
So anyway, I was on my HCA shift on an elderly care ward. I love this ward because although a lot of the patients are confused there are patients with some wonderful stories who’ve been in hospital for a while and want nothing better than to sit there and recount all their travels to you – it’s lovely. I was in a bay this time with a few distressed and sometimes aggressive patients I had been warned.

I had another HCA and a staff nurse working with me. One of the patients was on a mattress on the floor as they had no more low profile beds and he was a falls risk. He was due to be moved but I also questioned that – is it better for him to be on the floor, what about infection risk? Or do we risk putting him in a normal bed and him falling? What’s the right thing to do here? In light of the following events I’m glad he was in a mattress on the floor but I remember questioning it at the time. We got on with the morning work and at one stage I was in the bay alone. This man had been distressed all morning and tossing and turning trying to get up and out of bed despite being unable to stand. I turned my back for a minute and heard him cry out. I spun round and he was half way across the bay on his front with blood all down the front of his hospital gown. Turns out he had pulled his catheter out and was running away in the only way he knew how because he was disorientated and felt like he wasn’t safe. I yelled for help and got down beside him to reassure him and calm him down. I took his hand, looked him in the face and spoke to him calmly and he did begin to calm down. However then the nurse and HCA arrived and he riled up again.
Both this nurse and HCA were incredibly professional all morning, maintaining brilliant dignity when bed bathing patients and talking to them well but I think the nurse at this stage was frustrated with this patient. He had been distressed all morning and we had kept going back to calm him down. He had already pulled out cannulae and catheters before all of which had to be replaced and by this point I think the nurse was done being calm with him. THe nurse didn’t snap but was quite short with the patient and was just generally portraying a frustrated exterior – now this meant that calming the patient down took a lot longer because he picked up on the frustration and amplified it in himself.

Was the nurse being un-professional to outwardly direct his frustrations at the patient?

I don’t know, I know it didn’t sit right with me and I preferred to personally take the calm exterior approach however frustrated I was internally. But I can understand the reason for his frustration. The patient eventually calmed down, the catheter was re-fitted and he was calm for the rest of my shift even as he was hoisted and moved to a low profile bed. So the nurse getting frustrated had no repercussions – so was it unprofessional?

I can’t give you the answer and I don’t think most people can either, its more down to personal opinion. Professionalism is subjective and the most important opinion on whether or not you are being professional is that surely of your patients and your colleagues. If they perceive to be professional then you are, aren’t you? Even if not so much in your personal life?

Well that’s another debate right there. I’ll leave you with this thought:

‘Medicine is, in essence, a moral enterprise, and its professional associations should
therefore be built on ethically sound foundations. At the very least, when physicians
form associations, such occasions should promote the interests of those they serve.
This, sadly, has not always been the case, when economic, commercial, and political
agendas so often take precedence over ethical obligations. The history of professional
medical associations reflects a constant tension between self-interest and ethical ideals
that has never been resolved’

Thank you.

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