Codes of Professional Behavior for Medical School and Beyond

A study (NEJM Dec. 23, 2005 issue “Disciplinary Action by Medical Boards and Prior Behavior in Medical School” Maxine A. Papadakis, M.D and others) had shown that bad behavior in the later years of practice appear to be related to bad behavior which had been observed while the doctor was still in medical school.

Codes of professional behavior have been written by medical schools for their students to follow during their years in school. What should codes of professional behavior contain which we present to our medical students as they start out in their medical education? My opinion is that these codes not only should look at defining acceptable and ethical behavior of these students as they work in their educational environment in the classroom and on the hospital wards but also to emphasize to them they represent a “look ahead” to how they are expected to behave years from now when they have the full responsibility for patient care.

Here are my “look ahead” criteria definitions of honesty, integrity, responsibility, reliability, accountability and respect for patients which should be incorporated into medical schools codes of behavior, hopefully making the students understand why as students these elements of professionalism are necessary to observe now, identifying and correcting bad behavior to prevent loss of patients and even medical license in the future.


Honesty and Integrity:
Honesty and Integrity means Trust and Trust is the fiduciary responsibility that we must give to our patients and for which they expect from us.

Responsibility:
Responsibility includes the care of the patient that trumps the physician's self-interest.

Reliability:
Reliability means that the patient can depend on the doctor's medical skills and behavior to meet the challenges of patient care.

Accountability:
Accountability means that the physician is in the service of the patient and outcomes including medical errors and unattained goals or promises must be told and explained by the physician to the patient and whatever personal responsibility the physician holds should be accounted for.

Respect for Patients:
Respect for Patients means respect for their welfare as well as their autonomy. In addition, there must be respect for the patient's privacy (including issues of patient modesty along with any written or spoken personal details of the patient's life). There must be respect for the patient's religious beliefs, culture, their own personal view of the quality of their life and respect that the patient may be part of a family or other community.

Let me know if you have any suggestions about other points we should be teaching our students with regard to professionalism in medicine. ..Maurice.