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Charter on Medical/Dental Professionalism*

Final Approved Version
Schulich School of Medicine & Dentistry
Western University

Purpose

This charter is intended to serve as a set of guidelines to be referenced by all constituencies in the Schulich School of Medicine & Dentistry at The University of Western Ontario. It recognizes that traditional and often unwritten understandings of professionalism no longer suffice to address the stresses and temptations which currently face medical/dental professionals. Hence this document offers three fundamental principles upon which are built eleven responsibilities.

Preamble

Professionalism is the basis of medicine and dentistry's contract with society. It demands that the interests of patients are placed above those of the caregiver, that standards of competence be established and adhered to, and that expert advice be provided to society on matters of health. Essential to this contract is the public's trust in its physicians and dentists, and this, in turn, depends on the integrity of both individual physicians/dentists and the collective whole of these professions. For the contract to function, the principles under which it operates must be clearly understood by both the professions and society, thereby, generating an element of trust. It is recognized that in a school such as ours, charged by society with the education of physicians and dentists, all participants in that project, whether they be teachers or learners, have a responsibility to conduct themselves according to the tenets identified here.

Fundamental Principles

Principle of Primacy of Patient Welfare

Physicians/dentists must be dedicated to serving both the collective and individual interests of patients and take responsibility for guarding and promoting within themselves an inherent sense of altruism that resists contrary pressures from market forces, societal influences and administrative exigencies.

Principle of Patient Autonomy

Physicians/dentists must demonstrate respect for the autonomy of their patients by honestly informing them and empowering them to make their own decisions about treatment as long as those decisions fall within the boundaries of ethical practice and commonly held definitions of appropriate care.

Principle of Social Justice

Physicians/dentists must promote justice in the delivery of health care, actively working to eliminate discrimination based on race, gender, socioeconomic status, ethnicity, religion or, indeed, any social category.

A Set of Professional Responsibilities

1 Commitment to Professional Competence

Physicians/dentists must be committed to lifelong learning, and be responsible for maintaining the medical knowledge and clinical and team-skills necessary for the provision of quality care. This includes striving to ensure the competency of trainees and fellow members of the profession via adequate and appropriate educational resources.

2 Commitment to Honesty with Patients

Physicians/dentists must ensure that in a timely fashion patients are completely and honestly informed of the nature, expected outcome and risks of treatment before consenting to treatment. This expectation does not mean that patients should be involved in every minute decision about medical care; rather, they need enough information to make their best decisions. This implies that Physicians/dentists should also acknowledge that in health care, errors that injure patients do sometimes occur and that analyzing these mistakes provides a basis for appropriate prevention and improvement strategies as well as for rightful compensation to injured parties.

3 Commitment to Patient Confidentiality

Physicians/dentists must ensure that the appropriate confidentiality safeguards are in place to preserve patient confidentiality. This commitment extends to discussions with all persons acting on a patient's behalf. It is recognized that the obligation must occasionally yield to legitimate considerations deemed to be in the public interest.

4 Commitment to Maintaining Appropriate Relations with Patients

Given the inherent vulnerability and dependency of patients, physicians/dentists must commit to never exploiting them for sexual advantage, personal financial gain or indeed any private purpose.

5 Commitment to Cooperation and Collegiality

Physicians/dentists and basic science faculty and students must commit to work with other professionals, and allied health care agencies in a collegial and mutually respectful fashion. This attitude will lead to a comfortable and satisfying work environment for all, and ensures that the focus of health care delivery remains appropriately on the patient. Although constructive criticism is an essential component of the academic and health care environment and essential for life-long learning, it is unacceptable that denigration of other professionals, communities and organizations take place.

6 Commitment to Open and Honest Relationships with Colleagues and Third Parties

Within the framework of respect for patient confidentiality, physicians/dentists must strive for honest and complete communication with others in regard to issues relevant to their patients. This includes other health care colleagues, third party payers, the legal profession and insurance bodies.

7 Commitment to Improving the Health of the Community

Physicians/dentists must be dedicated to continuous improvement of the health of the communities for which they are responsible. This commitment entails not only maintaining personal clinical competence but also working collaboratively with other professionals to reduce error, increase patient safety, minimize inappropriate use of health resources, and optimize outcomes of care by measuring and modifying management where indicated.

8 Commitment to Improving Access to Care

Physicians/dentists must dedicate themselves to the pursuit of a uniform standard for health care that is readily available to all people. This pursuit includes the active identification of barriers to such a goal and the determined reduction of those barriers. This commitment to equity entails the promotion of public health and prevention of disease, as well as public advocacy.

9 Commitment to Scientific Knowledge

Physicians/dentists have a duty to uphold scientific standards, to promote research, to create new knowledge and to ensure its appropriate use. The professions are also responsible for the integrity of this knowledge, which is based on scientific evidence and clinical experience.

10 Commitment to Maintaining Trust by Managing Conflicts of Interest.

Physicians/dentists have an obligation to recognize, disclose to audit at arm’s length, and manage conflicts of interest that arise in the course of their professional duties and activities. In particular this extends to relationships between industry and professional authorities when the latter determine the criteria for conducting and reporting clinical trials, writing editorials or therapeutic guidelines, or serving as editors of scientific journals.

11 Commitment to Professional Responsibilities

As members of a profession, physicians/dentists are expected to work collaboratively to maximize patient care and to participate in the processes of self-regulation. This includes remediation and discipline of members who have failed to meet professional standards and the organization of educational processes and standard-setting for present and future physicians and dentists. In addition there is an obligation to engage in internal assessment and to accept and respond to external scrutiny of all aspects of their professional and educative duties.

* Derived from the paper produced by the Medical Professionalism Project of the American Board of Internal Medicine Foundation, the American College of Physicians-American Society of Internal Medicine, the American Board of Internal Medicine, and European Federation of Internal Medicine. Published in Ann Intern Med. 2002;136:243-246. Background on this project is available at www.professionalism.org last modified May 16, 2005 modified by WebManager