By Catherine DeAngelisDuring a difficult operation on a patient, a surgeon is handed the wrong instrument by the nurse assisting him. He screams at the nurse, “You gave me the wrong thing,” and throws the instrument across the room. The nurse immediately hands him the correct instrument, but she feels humiliated and the rest of the surgical team become anxiously fearful of another outburst. This scene is repeated all too often in hospitals, and the anxiety provocation in members of the health care team can lead to poor patient care. Is such behavior unethical or unprofessional — and is there any real difference between the two?
At some point in his or her life, virtually every person will require the care or assistance of a health professional. It is reasonable to expect that physicians, nurses, and all others who contribute to health care, will act professionally. Note that I did not say ethically, but professionally; for example, the behavior of the surgeon cited above was not unethical, but certainly unprofessional. Physicians are capable of acting unprofessionally, but cannot act unethically, as ethical standards are part of their profession. Therefore, it behooves all patients to educate themselves on what constitutes “professional” and “unprofessional” behavior for those involved in health care.
First, consider that it takes a team to care for patients, and that not all team members are considered members of the same profession. For instance, almost everyone can identify physicians and nurses as health professionals, but many other health team members also belong to different professions that have different professional standards. Others members of the team can include physicians, nurses, public health practitioners, dentists, pharmacists, social workers, lawyers, clergy, economists/businesspersons, and ancillary service persons, such as those who provide nutrition and maintenance of the environment (can you imagine a clinical setting without a maintenance group to assure cleanliness and functioning of the equipment?).
It is critical for patients to distinguish between differing standards of professionalism, depending on the specific health team member involved in their care. This enables patients to have reasonable expectations for the way they should be treated by health professionals – before, during and after their treatment. But how many real or potential patients actually know the professional standards of those who will care for them? Probably very few, although most have expectations for how they believe a health professional should behave. Most people would probably have some idea of the Hippocratic oath for physicians, but not many actually have read it and understand what it means. Similarly, most have heard of Florence Nightingale, but few know about how she laid the foundation for professional nursing and that a Florence Nightingale Pledge exists.
It is safe to conjecture that the vast majority of individuals know more about what to expect before buying a car than they do about putting their lives in the hands of health care professionals. However, since your life is certainly worth more than any other possession, why not take the time and effort necessary to know each health team member’s standards of professionalism?
Dr. Catherine D. DeAngelis is University Distinguished Service Professor Emerita, professor of pediatrics emerita at the Johns Hopkins University School of Medicine and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health. She served as the editor in chief emerita of JAMA, The Journal of the American Medical Association, and is the author of Patient Care and Professionalism.