The Changing Notion of Professionalism in Medicine

I had a fascinating time yesterday speaking at a medical professional development workshop at Einstein Medical Center. I was invited by my friend, Dr. Felise Milan, to discuss the ways that being a “professional” is changing in a world powered by social media. I built my talk largely from the post I had on a few months ago, but I was a little nervous because medical doctors are not my usual audience.

The concerns and questions from the group of experienced professionals were generally what I expected. How much time do I have to spend on the channels? Where is the dividing line between my personal and professional lives? Doesn’t this take away from the personal interactions I need to have with my students?

All fair questions and we discussed the importance of their leaning into the discomfort of working on channels like Facebook that by their very nature of being open and sharable make them nervous. We also discussed this moment in time as a transition  moment when the lines of what is public and private are fluid and particular to each person.

But in the breakout group discussion something fascinating emerged. The groups were given a photo similar to this one to  discuss:

Photo courtesy of NLS805

The story was that the man standing on the left was a doctor. He had cancelled an appointment with a patient because he was “sick”. Then this photo was posted on Facebook. Busted!  The small groups included faculty and students of the medical school. What was fascinating was the different lenses they used when looking at the photo. The faculty were appalled that this man would take the notion of being a doctor so lightly. As one participant said, “We have a higher standard of ethical behavior and we can be called on at any minute, whether in the office or at home, to save a life. This is appalling and unacceptable.”

It struck me that until that point I had been thinking of the notion of being a “professional” as the walls put up by people with their professional hats on. We dress a certain way, use a certain pen, write with a certain voice, etc. I had thought of these default settings as largely defensive mechanisms for keeping a distance from colleagues, clients and patients. A pretense that any person could be this objective, distant, impersonal purely professional person. David Stern (wow! was he brilliant!), explained that the ideal of doctors being “professional” isn’t about the doctor, it’s about the patient – about making them comfortable and serving them in ethical and caring ways.

That was an entirely new way for me to view the tension experienced folks have in taking down the walls. And certainly something to consider seriously as it applies to other professions without these particular ethical guidelines.

In addition, in the breakout groups, the students looked at the photo and said, “What’s the problem?” One said, if behavior like this was disqualifying, there wouldn’t be anyone left in medical school.” Really!? Binge drinking is just ho-hum? Faculty members were appalled (and, frankly, so was I, but I’m pretty prudish to begin with.)

The generational gap was reflective of both a comfort the students had with the binge drinking as a regular part of the college experience and their regular sharing of photos  – but also their yet-to-be developed sense their their online reputations affect their professional lives. People often ask me what happens if an embarrassing photo of them was posted on Facebook without their permission. And I ask them why they’re doing something so embarrassing in the first place. But maybe the very notion of what constitutes unacceptable behavior is up for discussion now.

All fascinating stuff I’m going to have to mull over. Hmmmm, starting to mull….


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Allison Fine

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