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Report on Professionalism

The QMA’s annual day was all about professionalism. At this event, Dr. Isabelle Samson, who is responsible for the professionalism component and the QMA’s Québec tour, presented the main results of the consultation.

You can now read the report on the QMA’s Web site or learn about the highlights of the document in the following summary of Dr. Samson’s presentation.

She started by explaining the historical and political context of the relationship between the medical profession, government and society. It is necessary to understand that just as the social contract evolves with the collective development of society and its expectations, so must medical professionalism.

Without strong medical professionalism shared by the entire community, the privileges granted the medical profession are at risk.


Restoring the public’s trust

Because of its special status, the medical profession is in effect a group that has organized itself into professional associations, and that has a standardized scientific education, strong moral values, and regulated professional, ethical and legal responsibilities. This gives it a social responsibility in addition to the necessary clinical expertise. In their practice, physicians must therefore achieve a balance between the interests of the patient and the interests of the entire medical community. 

However, in the last few years, due to the context of restricted public finances and the inability of the health care system to offer the population real access to care and services, the constant negotiations between physicians and the government have resulted in a great dissatisfaction that can be likened to doctor-bashing. This has even led to comments that the public has lost trust in the medical profession. 

And if the trust between the public and the medical profession is broken, the end result will have a detrimental effect on the direct relationship between physicians and their patients. Hence the importance today, according to the QMA, that the medical profession commit to redefining the social contract, in collaboration with the population and the government. The bond of trust that unites them must be restored and the QMA firmly believes that medical professionalism is THE solution to this crisis.


Finding the right balance

Physicians must find the right balance between the clinical and social aspects and thus the two components of professionalism – their role as a healer and their role as a professional.

With the Tour on Professionalism launched in the fall of 2017, the QMA aimed to make Québec physicians more aware of this issue while also helping them to develop a shared vision of professionalism. It was also an opportunity to talk with them about their ideas on the future of the profession.

Two findings emerged from the many comments gathered at these meetings with physicians in Québec’s various regions. Firstly, the role of healer and the role of professional seldom seem to be integrated among a large segment of the medical profession.

As well, although almost all physicians think that the status quo is unsustainable, few of them feel that they are part of the solutions or the means needed to initiate a change.

While it is not possible to talk about generalizing the results, the high recurrence of many themes suggests that the results are fairly representative of the profession. 


The professional role in the healer’s blind spot

First and foremost, physicians see themselves as healers. Teamwork, institutions, self-regulation and clinical autonomy are means to support the role of the healer rather than a full professional responsibility. The daily individual effort is so great for physicians that the collective effort becomes difficult.

And when physicians are criticized about the lack of access or high salaries, which they see as a rejection of their individual efforts, they are hurt even more.

“I have the impression that I give a lot, but society still thinks it’s not enough, and that is very discouraging.”

“I haven’t thrown in the towel on my patients, I will always continue that. But on a broader level, it’s difficult.”

“This is the age of communication and we don’t communicate well with patients. We don’t talk to the population collectively, it’s always through the media and representatives who are not like us.”


A strong feeling of exclusion

It was obvious to the physicians at the meetings that the bond of trust with the public is continuing to erode, and that the medical profession’s reputation is strongly affected.

Unfortunately, they feel powerless in the face of this tide of criticism and don’t see how they can take part in the solutions or changes needed to restore the relationship of trust between the profession and the population.

Some physicians would like to do something to change the situation, but don’t know how to go about it. For others, the efforts required seem excessive or the solutions are beyond their reach. Physicians also have the impression that their individual actions will not have much impact on the rest of the profession or that no-one will listen to them.

Finally, they feel excluded from the solutions, and some of them even think that the actions must come from elsewhere.

“Physicians have the duty to propose solutions, but we don’t know whose role it is to listen to them.”

“We should definitely be more involved, but we aren’t always invited to the table, it seems that we ask too many questions.”

“We shouldn’t be the only ones to bear the blame for the situation. Why is it up to us to restore our image when it’s the media and the government who have dragged us through the mud?”


The light at the end of the tunnel

During the Tour, the QMA suggested four potential solutions to help physicians take action in their daily practice as well as regarding their public image: demonstrate the values of medical professionalism every day, develop and support medical leadership, maintain clinical governance and redefine medical organization.

Options that were positively received for the most part. Almost all physicians were interested in developing their medical professionalism, which leads the QMA to believe that efforts to raise awareness of this concept have produced results.

In contrast, they are finding it increasingly difficult to show their leadership in the field. Among physicians who are currently involved in management functions or change initiatives, or who have been in the past, many are discouraged and disheartened by the obstacles to overcome and the difficulties in getting things moving.

Among the solutions, clinical governance seems to be the least relevant for physicians. However, it must be said that it is more complex to define. Finally, physicians feel that working on better medical organization could have a significant impact on their practice.

“Physician groups, entire congregations want to discuss practice conditions now, and not just compensation conditions. It’s very new.”

“We were not trained to be managers, I chose medicine to be a doctor, not to be a manager.”

“It’s in our best interests to train young physicians better on the organization/rules of their hospital, which would have an impact on their accountability (CPDP by-laws).”

The comments during the workshops clearly illustrate the physicians’ discomfort and the profession’s difficulty in initiating the necessary changes.

Historically, the selection, training and regulatory structure of physicians have encouraged the individual role of the physician as a healer, while society’s expectations are now focused on professional physicians as a community. It is therefore more important than ever for physicians to develop a collective vision of their profession and work together to restore the social contract.

But even if physicians believe in it, they are not necessarily ready to commit to something they don’t know how to do. Those who do so must be encouraged, supported and recognized by the medical profession.

Collectively, all physicians can implement winning conditions to help them in their environment. These could be through a financial contribution to enable physicians to perform management tasks, by supporting associations that represent, champion and promote the medical profession, by supporting initiatives in clinical environments, or by contributing actively to the best of their ability.