Professionalism and Mental Health by dfn15928

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									  Professionalism and
     Mental Health


Cheryl S. Al-Mateen, MD, FAACAP, FAPA
       Department of Psychiatry
        VCU School of Medicine
                                        1
Overview
• Professionalism – what is it?
• Professionalism at MCV
• Vignettes




                                  2
        Learned Professions

• Law             • Nursing
• Religion        • Occupational
• Medicine          Therapy
                  • Psychology
                  • Recreation
                    Therapy
                  • Social Work    3
                   The Oath of Hippocrates
I do solemnly swear by that which I hold most
    sacred
That I will be loyal to the profession of medicine
    and just and generous to its members
That I will lead my life and practice my art in
    uprightness and honor
That into whatsoever house I shall enter it shall
    be for the good of the sick to the utmost of my
    power, I holding myself aloof from wrong,
    from corruption, from tempting of others to
    vice
That I will exercise my art solely for the cure of
    my patients, and will give no drug, perform no
    operation, for a criminal purpose, even if
    solicited, far less suggest it
That whatsoever I shall see or hear of the lives of
    men which is not fitting to be spoken, I will
    keep inviolably secret…….
                                                      4
Psychology
• General Principles               • Ethical standards
   – Beneficence and                  –   Resolving ethical issues
     nonmaleficence                   –   Competence
   – Fidelity and responsibility      –   Human relations
   – Integrity                        –   Privacy and
   – Justice                              confidentiality
   – Respect for people’s             –   Advertising
     rights and dignity               –   Record keeping and fees
                                      –   Education and training
                                      –   Research and publication
                                      –   Assessment
                                      –   Therapy

                                                                     5
Social Work
• Ethical principles                   •   Ethical standards
    – primary goal is to help               – Responsibilities to clients
      people in need and to                 – Responsibilities to
      address social problems                 colleagues
    – challenge social injustice            – Responsibilities in practice
    – respect the inherent dignity            settings
      and worth of the person               – Responsibilities as
    – recognize the central                   professionals
      importance of human                   – To the profession
      relationships
                                            – To broader society
    – behave in a trustworthy
      manner.
    – practice within their areas of
      competence and develop
      and enhance their
      professional expertise


                                                                             6
American Psychiatric Nurse’s Association/American
  Nurse’s Association

• Provision 1. …practices with compassion and respect for
  the inherent dignity, worth, and uniqueness of every
  individual, unrestricted by considerations of social or
  economic status, personal attributes, or the nature of health
  problems.
• Provision 2: ...primary commitment is to the patient,
  whether an individual, family, group, or community.
• Provision 3: promotes, advocates for, and strives to protect
  the health, safety, and rights of the patient.
• Provision 4: is responsible and accountable for individual
  nursing practice and determines the appropriate delegation
  of tasks consistent with the nurse's obligation to provide
  optimum patient care
                                                                  7
American Nurses’ Association, cont’d

• Provision 5: owes the same duties to self as to others,
  including the responsibility to preserve integrity and safety,
  to maintain competence, and to continue personal and
  professional growth.
• Provision 6: participates in establishing, maintaining, and
  improving health care environments and conditions of
  employment conducive to the provision of quality health
  care and consistent with the values of the profession
  through individual and collective action.
• Provision 7. The nurse participates in the advancement of
  the profession through contributions to practice, education,
  administration, and knowledge development.
• Provision 8. The nurse collaborates with other health
  professionals and the public in promoting community,
  national, and international efforts to meet health needs.        8
American Therapeutic Recreation Association
  – Beneficence/non-maleficence
  – Autonomy
  – Justice
  – Fidelity
  – Veracity/Informed Consent
  – Confidentiality and Privacy
  – Competence
  – Compliance with Laws and Regulations
                                              9
Occupational therapy

Occupational therapy personnel shall…
    – demonstrate a concern for the well-being of the recipients of their
       services (beneficence)
    – take reasonable precautions to avoid imposing or inflicting harm upon
       the recipient of services or to his or her property (nonmaleficence)
    – respect the recipient and/or their surrogates as well as the recipient’s
       rights (autonomy, privacy, confidentiality)
    – achieve and continually maintain high standards of competence
       (duties)
    – comply with laws and Association policies guiding the profession of
       occupational therapy (justice)
    – provide accurate information about occupational therapy services
       (veracity)
    – treat colleagues and other professionals with fairness, discretion, and
       integrity (fidelity)

                                                                                 10
ACGME
 Residents must demonstrate a
 commitment to carrying out
 professional responsibilities,
 adherence to ethical principles, and
 sensitivity to a diverse patient
 population

                                        11
Charter on Medical Professionalism
  Professionalism is the basis of medicine’s
  contract with society. It demands placing the
  interests of patients above those of the physician,
  setting and maintaining standards of competence
  and integrity, and providing expert advice to
  society on matters of health. The principles and
  responsibilities of medical professionalism must
  be clearly understood by both the profession and
  society. Essential to this contract is public trust in
  physicians, which depends on the integrity of
  both individual physicians and the whole
  profession.                                              12
 Charter on Medical Professionalism
• Principles                  • Commitments
   – Primacy of patient        –   Professional competence
     welfare                   –   Honesty with patients
   – Patient autonomy          –   Patient confidentiality
   – Social justice            –   Maintaining appropriate
                                   relations with patients
                               –   Improving quality of care
                               –   Improving access to care
                               –   Just distribution of finite
                                   resources
                               –   Scientific knowledge
                               –   Maintaining trust by
                                   managing conflicts of
                                   interest
                               –   Professional
                                   responsibilities              13
Professionalism at MCV




                         15
The AMA Council on Ethical and Judicial Affairs (1980)
A physician shall…
1) be dedicated to providing competent medical service with compassion and
   respect for human dignity.
2) be honest with patients and colleagues and strive to expose those
   physicians deficient in character or competence or who engage in fraud or
   deception.
3) respect the law and a responsibility to seek changes in those requirements
   that are contrary to the best interests of the patient.
4) respect the rights of patients/colleagues and of other health professionals
   and shall safeguard patient confidences within the constraints of the law.
5) continue to study, apply and advance scientific knowledge, make relevant
   information available to patients, colleagues, and the public, obtain
   consultation and use the talents of other heath professionals when
   indicated.
6) in the provision of patient care, except in emergencies, be free to choose
   whom to serve, associate with, and the environment in which to provide
   medical services.
7) recognize a responsibility to participate in activities contributing to an
   improved community.                                                           16
Sources of Concern re: Professionalism

•   Medical student graduation questionnaire
•   AMA
•   AAMC
•   ACGME
•   LCME
•   ABIM
•   Local anecdotes
                                               17
VCU SOM Professionalism Task Force
 Report - 2001
  – Reviewed definitions
  – Assess MCV campus environment
  – Develop goals for enhancing MCV
    environment
  – Assist Dean’s office in maintaining
    professionalism
                                          18
VCU SOM Professionalism Task Force
Conclusions and Tasks
  – All unprofessional behavior is unacceptable….corrective
    actions will be necessary
  – Enhancing professionalism among the faculty, who
    serve as role models for others, will have a beneficial
    effect on these groups
  – There is limited evaluation of individual faculty members
    and students of professionalism in our school. A new
    series of evaluation processes is necessary
  – We need specific policies to deal with transgressions in
    professionalism
  – We need coursework on professionalism
  – A program to increase the awareness of medical
    professionalism in the entire community of VCU SOM
                                                                19
Components of Medical Professionalism

•   Altruism
•   Accountability
•   Excellence
•   Respect for others
•   Personal commitment to life-long learning
•   Duty
•   Honor and integrity
                              (KUMC definition)   20
Challenges to Professionalism
• Abuse of power    • Greed
• Discrimination    • Misrepresentation
• Bias              • Impairment
• Breach of         • Lack of
  confidentiality     conscientiousness
• Arrogance         • Conflict of interest
                          (KUMC definition)
                                              21
        Unprofessional Behavior
•   Unmet professional responsibility
•   Lack of effort toward self-
    improvement and adaptability
•   Poor interaction with patients and
    families
•   Inappropriate relationships with
    health care professionals            22
Teacher-learner relationship
  – Mutual trust
  – Respect
  – Responsibility
  – Professional manner
  – Focus on education
  – High quality patient care
  – Ethical conduct.
                                23
Vignettes




            24
A patient witnesses her
kitten being mauled and
killed by a pit bull. She is
in significant distress. She
has taken a picture of the
cat for legal purposes.
She has come to you for
treatment of anxiety
symptoms. She wants to
show you the pictures,
indicating that she feels
you cannot understand the
depth of her grief without
seeing the pictures.

                               25
Tape Vignettes

How could this
  situation present in
  mental health
  training?

How should it be
  handled?

                         26
VCU School of Medicine Standards
 of Professional Behavior
These standards describe behaviors expected from
faculty, housestaff, and students in the School of Medicine:

• Recognize their positions as role models for other
  members of the health care team.

• Carry out academic, clinical and research
  responsibilities in a conscientious manner, make
  every effort to exceed expectations and make a
  commitment to life-long learning.
                                                               28
• Treat patients, faculty, housestaff and students with
  humanism and sensitivity to the value of cultural,
  social, age, gender, disability and economic diversity
  without discrimination, bias, or harassment.

• Maintain patient confidentiality.

• Be respectful of the privacy of all members of the
  medical campus community and avoid promoting
  gossip and rumor.

• Interact with all other members of the health care
  team in a helpful and supportive fashion without
  arrogance and with respect and recognition of the
  roles played by each individual.                         29
• Provide help or seek assistance for any member of
  the health care team who is recognized as impaired in
  his/her ability to perform his/her professional
  obligations.

• Be mindful the limits of one’s knowledge and abilities
  and seek help from others whenever appropriate.

• Abide by accepted ethical standards in the
  scholarship, research and standards of patient care.

• Abide by the guidelines of the VCU Honor System.

                                                           30
“Bottom Line”

Medical Professionalism is an expected
behavior in all interactions
• Faculty
• Housestaff
• Support staff
• Students
                                         31
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               DEPARTMENT OF PSYCHIATRY
       EVALUATION OF RESIDENT'S PERFORMANCE



PROFESSIONALISM               1   2   3   4   5   6   7
Respect/Compassion            1   2   3   4   5   6   7
Ethics/Integrity              1   2   3   4   5   6   7
Cultural/Ethnic Sensitivity   1   2   3   4   5   6   7
Demeanor/Bearing/Appearance   1   2   3   4   5   6   7
Punctuality/Attendance        1   2   3   4   5   6   7



                                                          34
Faculty Evaluation for

  Professionalism



           ?
                         35
36
    Professionalism Committee Process


                               Discuss/guidance
Student
             Professionalism
Housestaff                     Modified Informal
             Committee
Faculty                        Complaint


                               Refer


                                                   37
School of medicine professionalism contact committee
•   Dr. Karen Sanders (Chair), VAMC
•   Dr. Cheryl Al-Mateen, Psychiatry
•   Dr. Diane Biskobing, Internal Medicine
•   Dr. Melissa Bradner, Family Medicine
•   Dr. Jan Chlebowski, Graduate Education
•   Dr. Ron Clark, Internal Medicine
•   Dr. Ray Colello, Anatomy
•   Dr. Philippe Girerd, OB/GYN
•   Carol Hampton, Faculty and Instructional Development
•   Dr. Walter Lawrence, Surgery
•   Dr. Joyce Lloyd, Human Genetics
•   Dr. James Messmer, Undergraduate Medical Education
•   Dr. Mary Alice O’Donnell, Graduate Medical Education
•   Dr. Andrea Pozez, Surgery
•   Dr. Elizabeth Waterhouse, Neurology                    38
SOM Professionalism Website


http://www.medschool.vcu.edu/professionalism/




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