Professionalism in Surgery

Chapter 5 Professionalism in Surgery



Joel C. Rosenfeld, MD, MEd, Linda L. Blank


Professionalism is the defining aspect of an occupation, which implies mastery of a complex body of knowledge and skills. Although many definitions exist, the common elements presume a commitment to competence, integrity, morality, and altruism over self-interest as well as a contract with society that strives to guarantee these qualities.1–4 Central to the tenets of professionalism is the doctor’s indefatigable commitment to provide humanistic patient care.5


The ACGME competency on professionalism states: “Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.”6


In 1999, the American Board of Internal Medicine Foundation, American College of Physicians Foundation, and European Federation of Internal Medicine combined efforts to launch the Medical Professionalism Project.7 These three organizations jointly developed a “physician charter,” which provides a contemporary definition of professionalism that encompasses a set of principles to which all physicians should aspire. The charter identifies what physicians must do to fulfill the commitments inherent in the profession’s social contract, including placing the interests of patients above their own, setting and maintaining standards of competence and integrity, and providing expert advice to society on matters of health.8,9


Specifically, the charter articulates three fundamental principles and ten professional commitments:


Principles: (1) principle of primacy of patient welfare; (2) principle of patient autonomy; (3) principle of social justice

Commitments: (1) to professional competence; (2) to honesty with patients; (3) to patient confidentiality; (4) to maintaining appropriate relations with patients; (5) to improving quality of care; (6) to improving access to care; (7) to a just distribution of finite resources; (8) to scientific knowledge; (9) to maintaining trust by managing conflicts of interest; and (10) to professional responsibilities9

In 2003, the American College of Surgeons (ACS) similarly established a Task Force on Professionalism, which developed a Code of Professional Conduct for surgeons.10


The Principles and Commitments of the Charter on Medical Professionalism, the ACS Code of Professional Conduct, the Oath of Hippocrates,11 and the ACGME Definition of Professionalism are represented by different colors in Table 5.1. The similarity of these four ethical codes is readily apparent. In each chapter of this book, the surgeon-contributor included a section about professionalism that pertains to the case discussed. Table 5.1 lists these contributions aligned with the most relevant professionalism principles and/or commitments.


Table 5.1 Professionalism and Cases











Professionalism Principles and Commitments Cases

Principle of primacy of patient welfare

• (ACS) Serve as effective advocates for our patients’ needs

• (ACGME) Demonstrate respect, compassion, and integrity
 10, 35, 42

Principle of patient autonomy

• (ACS) Encompass within our surgical care the special needs of terminally ill patients

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Mar 20, 2017 | Posted by in GENERAL SURGERY | Comments Off on Professionalism in Surgery

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