Physician Accountability and Taking Responsibility for Ourselves: Washing the Dirty White Coat, One at a Time
This is a difficult scenario to envision as numerous barriers will need to be overcome, not the least of which are imposed by a economically driven health care system embracing profits over principle coupled with a stifling legal climate in which the aggrieved can disappear amid volumes of legal gibberish. Oversight officials cave in to less expensive settlements while poor professional behavior goes unchecked.
Educational institutions are now challenged with providing evidence that programs are making data-driven improvements by documenting learner performance. Of the six prescribed competency domains including patient care, medical knowledge, practice base learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice, the most difficult to document are those involving interpersonal and communication skills and professionalism. Historically, the heart of the medical education system for measuring physician achievement has been in the assessment of medical knowledge, the most easily documented aspect of physician achievement through standardized testing. As such, medical knowledge has been taken as a surrogate for defining competent physicians and educational institutional excellence by those responsible for accreditation, licensure, certification, and recertification. Although medical knowledge is important to provide good patient care, equally important are professionalism and communication skills necessary to be good doctors. An earlier article discussed aspects of professionalism, quality care, and professional self-regulation.1 The authors made reference to professional liability issues revolving around high-claim physicians and their failure to communicate to or show lack of respect for patients and their families. While assessing quality outcomes and meeting expected academic standards are important, additional areas related to the selection and assessment of individual behaviors are also important as a matter of risk management as they relate to professionalism and ethical behavior.
Various models of accountability in health care have been developed to include the professional model that guides the physician–patient relationship, the political model that operates within managed care plans and other integrated health delivery networks, and the economic model that brings to light market influences and consumer choice.2 The root of some of the failures in our health care system lie in the confusion of these models encouraged within a for-profit health care system, which attempts to portray physicians as caring professionals while forcing them to act like economic producers. The purpose of this article is to deal with aspects of individual professional accountability while acknowledging that to do so, one needs to accept the larger context in which the individual physician works.