Spot on.
No one agrees on definition of #professionalism.
Differs by field & setting within medicine.
Let’s be more precise.
There are several cultural and system changes/shifts happening in healthcare that change interactions, expectations, parameters.
#MedTwitter
No one agrees on definition of #professionalism.
Differs by field & setting within medicine.
Let’s be more precise.
There are several cultural and system changes/shifts happening in healthcare that change interactions, expectations, parameters.
#MedTwitter
https://twitter.com/dr_bowser/status/1345546794835599361
More from @Dr_Bowser - yes, #professionalism is diffuse, varied
It quickly devolves into
shaming labels
in/out group
(=You do not belong in the profession/club)
Fear of being ostracized
to enforce “rules” that are
nebulous
not verifiably mapped to quality
often indefensible
It quickly devolves into
shaming labels
in/out group
(=You do not belong in the profession/club)
Fear of being ostracized
to enforce “rules” that are
nebulous
not verifiably mapped to quality
often indefensible
https://twitter.com/dr_bowser/status/1345546071150370816
Methods to exclude, ostracize, label as “out group”
are hallmarks of bullying
which we know is too prevalent in medicine and education
Not everyone who uses term “professionalism” intends to/is a bully but many of us are complicit
are hallmarks of bullying
which we know is too prevalent in medicine and education
Not everyone who uses term “professionalism” intends to/is a bully but many of us are complicit
It JUST clicked for me with this from @NatsforDocs on #impostersyndrome why “#professionalism” term is so able to activate shame to psychologically activate “I don’t belong” and “I’ll be excluded” - that too when to get into med school was constant anxiety-driven overachievement
https://twitter.com/natsfordocs/status/1345747980662390784
There is a very pragmatic and important aspect to group belonging especially in high acuity or high risk settings. The same is true in #military settings too. “Who has your back”? This is necessary for patient safety. Really robust exchange with on #professionalism
But these “tight” groups - medicine/surgery or military - that rely on trust, also can be unwilling to “report” cuz it seems like betrayal, risk of ostracization.
This has been my repeated barrier to cultural change to #safetyculture.
Safety hits VERY close to home for me.
This has been my repeated barrier to cultural change to #safetyculture.
Safety hits VERY close to home for me.
https://twitter.com/usnehal/status/1115949905086955525
It is a lose-lose.
Ethical thing to do is report an error or harm or bullying.
In settings lacking #growthmindset or no-shame reporting, then reporting reserved for those against whom a grudge/vendetta.
Yet, without reporting we cannot find system breaks/vulnerabilities.
Ethical thing to do is report an error or harm or bullying.
In settings lacking #growthmindset or no-shame reporting, then reporting reserved for those against whom a grudge/vendetta.
Yet, without reporting we cannot find system breaks/vulnerabilities.
https://twitter.com/usnehal/status/1212892206211780610
Need systems thinking. Individual heroism is what society loves stories of and often expects from leaders.
The quiet, invisible, unglamorous work of system design is what makes us safe, effective, consistent. We see that with #COVID19 #pandemic or #vaccine rollout.
The quiet, invisible, unglamorous work of system design is what makes us safe, effective, consistent. We see that with #COVID19 #pandemic or #vaccine rollout.
#Quality & #safety came from surgery world (not to ding all surgeons)
Some time ago a doc from a surgical background shared an article calling preventative health/vaccines “coercive” 😱
Prevention = systems, not heroism
Is it any wonder our system fails on #publichealth?
Some time ago a doc from a surgical background shared an article calling preventative health/vaccines “coercive” 😱
Prevention = systems, not heroism
Is it any wonder our system fails on #publichealth?
https://twitter.com/usnehal/status/1267132031936405504
Personal responsibility is essential
At the same time
when the system itself is
rife with error
not coordinated
depletes/exploits all individuals
utilizes shaming for behavior control
#professionalism may be
saying “no”
setting limits
disrupting
reporting
standing alone
At the same time
when the system itself is
rife with error
not coordinated
depletes/exploits all individuals
utilizes shaming for behavior control
#professionalism may be
saying “no”
setting limits
disrupting
reporting
standing alone
Where do we get standards? Where are they written? Who wrote them?
If subjective, then which person decides and who do they consult? How do they control for bias?
Who starts off already outside the profession based on historical precedent?
Women
Minorities
Chronically ill
If subjective, then which person decides and who do they consult? How do they control for bias?
Who starts off already outside the profession based on historical precedent?
Women
Minorities
Chronically ill
These are questions I’ve been wrestling w/ a decade
since my first physician executive role where I had oversight, disciplinary authority, power to terminate my peers
things I complied with as a front line clinician, to fit into culture
felt wrong
I started to see these biases
since my first physician executive role where I had oversight, disciplinary authority, power to terminate my peers
things I complied with as a front line clinician, to fit into culture
felt wrong
I started to see these biases
In exec suite saw more factors. No longer a profession, an industry.
Non-profits orgs’ board members from for-profit companies
=mindset
The business model exploits, depletes workers. Physicians are employees, no longer leaders. Porter’s 5 forces applied
=hire cheapest clinician
Non-profits orgs’ board members from for-profit companies
=mindset
The business model exploits, depletes workers. Physicians are employees, no longer leaders. Porter’s 5 forces applied
=hire cheapest clinician
Who defines my professionalism? Is it him?
Am I to be on my knees
depleted, broken
giving to my patients & to those junior while I lose my own ability to fly (work)
I wrote a response to this & got named “Top 15 female voices in the World” by LinkedIn
Power via budgets tho
Am I to be on my knees
depleted, broken
giving to my patients & to those junior while I lose my own ability to fly (work)
I wrote a response to this & got named “Top 15 female voices in the World” by LinkedIn
Power via budgets tho
Shaming “professionalism”
“sacrifice” glorified
misused
blocks
harms
Acknowledge an illness?
“Lacking professionalism” (“Weak”)
Seek resources to support outcomes?
“Lacking professionalism” (“Selfish”)
When female faculty have extra demands
Then BIPOC biases too
“sacrifice” glorified
misused
blocks
harms
Acknowledge an illness?
“Lacking professionalism” (“Weak”)
Seek resources to support outcomes?
“Lacking professionalism” (“Selfish”)
When female faculty have extra demands
Then BIPOC biases too
In fact, the constant ablism & shaming of of those who acknowledge human physical and mental health reality is what gives us this problem
The 2x times in my career I tried to take a sick day, “professionalism” invoked
Once when I did come in: syncope
pubmed.ncbi.nlm.nih.gov/20549378/
The 2x times in my career I tried to take a sick day, “professionalism” invoked
Once when I did come in: syncope
pubmed.ncbi.nlm.nih.gov/20549378/
There may be legislation named after Dr. Lorna Breen & we all may cite her in different ways
but what are we doing to change this culture?
such that she felt that acknowledging she had gotten depleted by an underresourced system was a source of shame?
Bad systems break humans
but what are we doing to change this culture?
such that she felt that acknowledging she had gotten depleted by an underresourced system was a source of shame?
Bad systems break humans
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