Humanism and Professionalism in Medicine

About a month ago, I was invited by one of the Hospital’s departments, where we provide postgraduate courses and specialty certifications in a highly complex area of Medicine. I was to accompany a retired Clinical Professor from both the public and private medical schools, who at present devotes himself to investigate, publish and teach in the rich areas of Medical Humanism and Medical Professionalism. When he turned eighty, he published a book, where he both synthesises and expands on both concepts. The residents are asked to read the book reflectively and to write either a summary or the impressions they have, of the specific chapters covered in each of the fortnightly workshops and describe a personal encounter with a patient, that is relevant to the subject. My natural anxiety made me read the book from cover to cover in less than a week.

The author distinguishes between Humanism and Professionalism, their different sources, history and relevance to modern medical practice. After reading through the book, I summarised my impressions and did my homework. What follows is what I wrote and presented at the following meeting.

“In the first place, Professionalism has to do with a set of rules, that have their source in the person of the physician, either alone or as a group, from those who require their services and from the society within which they practise. Therefore, those who choose the medical profession, have to abide by these rules that regulate how he or she behaves, individually and with relation to his or her colleagues, with their patients, with the organisations within which they work and finally, with organised society as a whole. These rules may be explicit in laws, codes of ethics, collegial associations and by international entities like the World Medical Association and the World Health Organisation. They provide the necessary uniformity between doctors and define the standards of what constitutes being a physician, how they should be trained and how they should practice. Besides, by restricting what doctors do to those professionally qualified, physicians are given a monopoly and exclusive rights over what is considered medical practice.

“In a rather restrictive and reductionist view, I would describe Professionalism as a vessel, bottle or box, that is similar in looks and label with other vessels. Society can therefore tell, who qualifies professionally as a doctor from who doesn’t.

“Humanism, on the other hand, isn’t exclusive of physicians. Humanism has to do with persons, in a sense: with everybody. It has to do with one’s values and how they relate to the deepest questions that life poses to all of us. In other words, Humanism has to do how each of us confronts our own existence. Humanism has to do with the inevitability of our finitude and eventual death, with disease and suffering from all causes, with guilt and what meaning we strive to give to these inevitable dimensions of our own existence. Humanism, therefore, is what gives life to Professionalism, which I described earlier as an inert container.

“The vessel of Professionalism should be filled with the contents of Humanism. Without Humanism, empathy and compassion are impossible. However, these contents are at risk of deteriorating or emptying themselves over time, if the physician is not proactive to keep them fresh and full. Sadly, in the present century, we are to some extent living a crisis of Humanism, reflected in physician burnout (exhaustion, cynicism and lack of accomplishment) and worse so, in the worrying incidence of physician suicide. Therefore, Humanism should be taught, renewed and made central to doctors’ worldview and the vessel of Professionalism kept fresh and full, so as to keep physicians engaged in work, with meaning, happiness, empathy and compassion. Isolated Professionalism is empty and potentially selfish, both personally and corporatively and therefore damaging to a healthy doctor-patient relationship.”

Reference: Correa, H. Humanismo médico. Montevideo: Fin de Siglo, 2016.