profession is an occupation whose core element
is work based on the mastery of a complex
body of knowledge and skills. It is a vocation
in which knowledge of some department of
science or learning, or the practice of an art
founded upon it, is used in the service of
others. Its members are governed by codes of ethics and profess a
commitment to competence, integrity and morality, altruism and
the promotion of the public good within their domain.
These commitments form the basis of a social contract between
a profession and society, which in return grants the profession
a monopoly over the use of its knowledge base, the right to
considerable autonomy in practice and the privilege of self-
regulation. The implicit understanding in this contract is that
professions and their members are accountable to those served and
Ultimately, when we speak of professionalism we are talking about
the cognitive, moral and collegiate attributes of professionals and
how these attributes connect the core values of the profession with
the expectations of society.
BEYOND THE HIPPOCRATIC OATH
The last 20 years has seen enormous progress in addressing
professionalism. Beyond the Hippocratic Oath we have discovered
professionalism in a fuller sense, providing definitions and
documentation as well as assessment. The concept has been
institutionalised with multiple codes, charters and competencies
and the design of procedures to handle breaches of professionalism.
In conjunction with this, there has been a significant increase
in our understanding of the social requirements placed upon
us, as medical practitioners. We are now becoming more aware
of individual professionalism within our organisations and the
increased requirement for collective responses.
But the development and maintenance of medical professionalism
is an ongoing task and new challenges are continually emerging. We
need increasing awareness of how organisations such as complex
hospital structures work and how our cultures will impact upon
them. However, the exercise of medical professionalism can be
hampered by the political and cultural environment of health.
The complexity of the challenges is increased by the reality that
medicine bridges the gap between science and society. In this
context, one thing is clear; the public understands a lack of
professionalism is detrimental to their interests. So, for the public
and for doctors, medical professionalism is at the heart of being a
With this realisation has come the understanding that delivery of
high-quality health care depends on effective health teams and
efficient health organisations. It is now increasingly recognised that
surgery is no longer primarily exemplified by the role of the `master-
surgeon' but by the adept and skilful `team leader'. This raises the
question as to whether we are training and upskilling all of our
surgeons for this?
A THREAT OR OPPORTUNITY FOR THE ROYAL COLLEGES?
MEDICAL PROFESSIONALISM IS AT THE HEART OF BEING A GOOD DOCTOR. THAT
WAS A CORE MESSAGE FROM ASSOCIATE PROFESSOR MICHAEL HOLLANDS,
PRESIDENT OF THE ROYAL AUSTRALASIAN COLLEGE OF SURGEONS IN HIS
KEYNOTE LECTURE AT RCSI'S CHARTER DAY IN FEBRUARY. IN THIS EXTRACT FROM
THE LECTURE, ASSOCIATE PROFESSOR HOLLANDS DISCUSSES THE DEVELOPING
CONCEPT OF MEDICAL PROFESSIONALISM AND ITS IMPLICATIONS
Associate Professor Michael Hollands, President of the Royal Australasian College of Surgeons, is pictured with Professor Patrick Broe, RCSI
President and Ms. Laura Viani, RCSI Council Member.