The New Professional Physician: What Does It take?

Edna Astbury-Ward

Disclosures

May 13, 2019

What does it take to be the new professional physician? That was a question posed at the recent Royal College of Physicians conference in Manchester.

The session described the impact of poor behaviour and concluded that it is possible to manage poor behaviours, but it is not always easy.

It was presented by Dr Judith Tweedie, a research fellow to the president of the Royal College of Physicians (RCP).

   

Judith Tweedie

Dr Tweedie is involved in project management, leadership, management and policy research. Dr Tweedie works across different organisations such as NHS England, Health Education England (HEE) and the National Institute for Clinical Excellence (NICE). She is part of a team working on the RCP Future Hospital Chief Registrar scheme, which offers an annual training programme to enable registrars to gain the necessary skills to become future leaders. She was involved in setting up the project, developing the training components, managing publicity and dealing with the stakeholders.

Dr Tweedie is currently completing an MD in Medical Education at University College London, where her research explores how doctors form their professional identity.

She spoke to Medscape News UK about her work and research.

Q&A

What do you mean by the professional physician?

Before we talk about the professional physician it is important to recognise what unprofessional is, and unprofessional behaviours have an impact on patient safety.

Good medical practice has a certain set of standards and criteria that enable us to maintain patient safety. Obviously when those standards are compromised by unprofessional behaviour, patient safety may be jeopardised.

Can you prevent that from happening?

Yes, I do believe you can; obviously we have to have systems and structures in place to support that, but more importantly it is about how we support our colleagues, so that we can do the best we can in our jobs for our patients.

So that fits with your MD research looking at how doctors form their own professional identity?

Yes, absolutely. Initially I had a broad topic area to look at professionalism, but the idea of judging someone just on observable behaviours didn't really fit that well with my philosophies. I find the concept of identity formation fascinating. Identity formation is the process by which a professional, such as a doctor, brings together their own values, expectations and beliefs, and learns to merge that with what it means to be a doctor. I think it's a really interesting area to explore.

The University of Liverpool has a theme lead for professionalism, values and ethics. Why do we need to teach medical students about this?

We need to teach them about it because it's tough. Its really tough. Sometimes the clinical things are easier to learn than the non-clinical because there's guidelines, there's evidence, there's a path to follow for the day-to-day things, so it's easier than the nebulous stuff, the grey areas of medicine. We also have a set of standards and good medical practice that lays that all out: what is professional, what is not professional, but that can be very grey at times as well.

What are those grey areas?

The ethical challenges, taking your own values and your beliefs and melding them so you are shaped into a doctor. I don't know if you can teach it all, but certainly, I think we can support people and help them progress and develop as medical students, and afterwards to try and deal with some of these difficult situations.

Has your research on doctor's professionalism unearthed any surprises?

Oh yes. I cannot believe how much influence consultants have on junior doctors, in terms of how they can make them feel about their job, their confidence, their competency. You know, people describe having a consultant say "thanks for doing the ward round". And they use words like "it made me feel joyous", or "made me feel valued". I think that's been a real, big learning part for me.

Is there a flipside to that?

Yes, sometimes consultants may judge other doctors by their own values. Say for example if they think timeliness is important, they will judge whether or not the doctor is a good doctor, based on maybe one of their own criteria. But essentially, we are all part of this community, we all have our views. We all have our own values. And we all have our own things such as maybe timeliness or good communication or being active in research that we think are important as a doctor, and I guess it's about learning that it's having a mix that's important.

Do you think that we can train medical students to understand the importance of this? Isn't it just down to their own internal moral compass?

I'm not sure if we can necessarily train them. But I definitely think that universities, medical schools and postgraduate medical environments, can put systems and processes in place to help support people as they develop as individuals and as professionals.

You said when people behave unprofessionally, you need to look at the underlying issues. Could you explain what those underlying issues are? And how you deal with them?

You need to look into your external and internal factors. The reason people may be unprofessional, they may have addiction problems, they may have mental health problems, research shows us that certain personality types can suffer more. People who struggle with conflict resolution and negotiation and may get into more difficulties. Being a medic, or nurse, or pharmacist, or whatever, doesn't prevent you from the life events that everyone else has, such as getting sick, elderly parents, sick children, being divorced, all of that can contribute, as well as working in systems that are ill equipped to handle concerns. I think we need policymakers, educators and regulators to take a broader look at this. I think sometimes we want to oversimplify things. But actually, if we want to manage it, and we want to help people do the best they can in their job, you need to take a broader, wider perspective.

Do you think we are aware of those underlying traits in doctors?

Well the evidence suggests that those personalities who struggle with conflict resolution and the like, are the ones who may be drawn to that particular unprofessional behaviour… that magnetism…

What's surprised you about your research?

It's been a total gift and privilege over the last couple of years, to have people tell me about their experiences, and tell me about their motivations, and tell me the things that have brought them joy in their work and the things that brought them stress. So in a way, it's been a surprise, heart open, how much people have shared with me in doing this work, it's been definitely a total privilege.

How have you been shaped by your research?

I do believe and hope that I, as a consequence of all I've done, I'll be a better doctor. I go back to practice in August. I've just been so lucky to develop this broad set of skills that I really hope will help me do better as well.

What's your message to trainees?

I think the work I've done over the last couple of years has been quite challenging at times, which is good. I think what keeps you going is your interest in it. So, my piece of advice would always be, find out what your niche is and find out what you're interested in. Don't do things for the sake of it. It's your life, you have one life, do things because you're interested in them.

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