Επαγγελματισμός και Ιατρική Σχολή

[Sovereign]

Ενδιαφέρον άρθρο έχει το τεύχος Νοεμβρίου του Annals of internal

medicine σχετικά με ένα θέμα που τείνουν να ξεχνούν οι Ιατρικές Σχολές

μας (αν ποτέ το θυμήθηκαν). Ο λόγος για τη διδασκαλία του

επαγγελματισμού στους φοιτητές Ιατρικής, το αυριανό ενεργό

επιστημονικό δυναμικό της χώρας.

Γιατί καλή η γνώση του γονιδίου της οικογενούς πολυποδίασης του

εντέρου, αλλά κάποια άλλα πράγματα ίσως να έχουν μεγαλύτερη σημασία

προπτυχιακά, μια και αύριο (σε 15 χρόνια όσοι θέλουν Ενδοκρινολογία-

χα!) θα κλειθούμε να ανταπεξέλθουμε σε πολλά πιο σημαντικά ερωτήματα..

EDITORIAL

Professionalism and the Medical Student

Charles K.Francis, MD

2 November 2004 | Volume 141 Issue 9 | Pages 735-736

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According to the Charter on Professionalism (1), 3 principles lie at

the core of professionalism in medicine. The first principle, primacy

of patient welfare, stresses altruistic dedication to the well-being

of the individual patient. The second principle, patient autonomy,

urges physicians to facilitate patient involvement in treatment

decisions. The third core principle, social justice, calls upon

physicians to work actively toward equitable societal distribution of

health care resources.

In the poignant essay "A Lesson from the Third Year" (2), which

appears in this issue, a medical student caring for an elderly Chinese

immigrant encounters each of the 3 core principles of professionalism.

The problems the student faces in the care of this patient (cultural

isolation, lack of English proficiency, undocumented immigrant status,

homelessness, poverty, and lack of medical insurance) are largely

social problems. However, these social issues form the context in

which physicians deliver health care, and they provide opportunities

to apply the principles of professionalism. The story of this medical

student and his patient underscores that medical school presents a

unique opportunity to nurture the core principles of professionalism

in the physicians of tomorrow.

For the medical student in this essay, primacy of patient welfare was

a driving force. The student offered the only things he had as a

student—"my time, my ear, and my voice"—for the benefit of his

patient. The principle of patient autonomy—empowering informed

treatment decisions—presented special challenges in this patient's

care, primarily because of language and cultural barriers. The student

must have wondered whether this 70-year-old man would have elected

dialysis, kidney transplantation, or nursing home placement if he had

fully understood his predicament and was able to make decisions about

his care. However, the student's most difficult struggle is with

social justice, a principle that urges physicians to work actively to

eliminate discrimination in health care and to assure fair

distribution of finite resources. The student's patient, an uninsured

illegal immigrant, raises thorny questions about just allocation. In

our society, health professionals are faced with a seeming paradoxical

choice between the primacy of patient welfare, which puts the

interests of the individual patient first, and the fair distribution

of limited resources, which urges respect for societal resource

limitations. This apparent conflict can be overcome through a

commitment of the medical profession to professionalism. The principle

of social justice not only informs decisions made within the health

care system but also informs those made in caring for an individual

patient. Professionalism includes an imperative to remove social and

cultural barriers to high-quality cost-effective health care,

especially for people who are disadvantaged and marginalized. The

principles of professionalism can shape the intellectual framework

that physicians bring to their clinical experiences, foster greater

understanding of their responsibilities, and teach them to offer and

demand moral and ethical evidence and justification for their clinical

behavior.

Medical school presents a unique opportunity to establish a foundation

for professionalism that students can build upon throughout their

careers. Even though development of professionalism has become a focus

of medical school and postgraduate physician education, current

teaching too often fails to take advantage of the actual situations

that students encounter in the wards and clinics. Consequently, we

miss powerful opportunities to teach students how to apply the

principles of professionalism in the social and cultural context of

daily practice.

[NIKITA]

Πολύ ωραίο θέμα, το διάβασα λίγο πριν μπώ εδώ και το ξαναδώ μπροστά μου!!!