Letters to the Editor
To the Editor:
We read the narrative by Chin-Yee1 repeatedly. The episode was not only vividly described but also well reflected upon. Professionalism is a core physician competency. The author correctly acknowledged professionalism as a key component of medical education and training. Although professionalism encompasses three domains (knowledge, skills, and attitudes/conduct), we agree with the author that professionalism is more a virtue than a skill. Also, the Royal College of Physicians has suggested that, “Medical professionalism as a set of values, behaviours, and relationships that underpin the trust the public has in doctors.”2
Although the patient was brought to the emergency room near the end of his overnight shift, the author attended to him without hesitation. That is altruism. In the early hours, who could possibly be there to witness, or more so, to assess such display of professionalism? Even multisource feedback might not have captured such behavior. Nonetheless, he took it in stride. That is integrity. Despite the confrontation and verbal abuse by the patient, he proceeded to attend to his injuries. That is compassion and commitment. The author also compared himself with the patient and admitted he was much more privileged than the poor patient, whose circumstances might have contributed to his current state. That is honesty and empathy.
In the face of numerous challenges, the author was able to foster empathy and displayed the finest professional values and behaviors during his actual performance at the workplace, while reflecting on the episode. In terms of assessment of professionalism, such competence lies at the highest level of Miller’s3 pyramid of clinical competence—the level of “Does.”
Papadakis and colleagues4 found that disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school. Conversely, could such a fine display of professionalism by this fourth-year medical student augur well for the future of an ethical and reflective physician?
Joong Hiong Sim, PhD, MEd
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia; email@example.com.
Hamimah Hassan, MSC, MBBS
Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
1. Chin-Yee B. Learning professionalism under stress. Acad Med. 2017;92:307.
2. Working Party of the Royal College of Physicians. Doctors in society. Medical professionalism in a changing world. Clin Med (Lond). 2005;5:S5–S40.
3. Miller GE. The assessment of clinical skills/competence/performance. Acad Med. 1990;65(9 suppl):S63–S67.
4. Papadakis MA, Teherani A, Banach MA, et al. Disciplinary action by medical boards and prior behavior in medical school. J Med Licensure Discipline. 2006;92:11–20.