Our Generation: Defining professionalism

Early one morning, a nurse pulled me aside and asked to speak to me about a medical student she "had a problem with." The medical student, the nurse said, was not being professional. Was the student disrespectful to the nurse or a patient, I asked, or was she not writing her notes, not appropriately examining patients, or being dishonest or irresponsible? No, the nurse said; it was none of those things. The student was wearing a top that exposed her midriff and she had a tongue ring.

Personal appearance is only one aspect of professionalism, albeit perhaps the most obvious. Many characteristics differentiate a professional from a layperson, among them a calling that requires specialized knowledge and often entails long and intensive academic preparation. Decades ago, when fewer people pursued higher education and our specialty was unencumbered by commercialization, it probably was much easier to recognize and emulate a "professional."

In the literature, professionalism has been linked to virtues, obligations, behaviors, and morals. And that is precisely what makes it difficult to consistently define what constitutes a digression from the accepted standard. As society redefines what's acceptable, so, too, do our ideals of professionalism. In other words, what makes perfect sense to ob/gyns from the Greatest Generation or Baby Boomers may make no sense to ob/gyns from Generation X and Y.

I very much disagree with the aspersions about Generation Xers. But I confess that I do wonder how the young residents and medical students I talk to plan to live a balanced life and practice ob/gyn without working long hours, sacrificing some personal free time, or making a commitment to lifelong learning. Perhaps they-and that medical student with the bare midriff and the tongue ring-need more guidance from we "elders" on what it means to be a professional.

According to the National Board of Medical Examiners, a nonprofit organization that administers the US Medical Licensing Examination, "professionalism" means competency in seven categories: Altruism; Responsibility & Accountability; Leadership; Caring, Compassion & Communication; Excellence & Scholarship; Respect; and Honor & Integrity. And there under the heading of Responsibility & Accountability is this bullet point: "cares for self appropriately and presents self in a professional manner." The NBME Web site goes on to further elucidate: "adheres to the local dress code." Perhaps my medical student's attire was appropriate-for her local dress code, if she were practicing in, say, SoHo and not Phoenix. Maybe, I thought, it's possible to teach professionalism.

Then I pondered a little more and wondered whether the Greatest Generation had similar qualms about us Baby Boomers as we came into the specialty. Is professionalism seriously deteriorating or is the development of professionalism a process of maturity? In our culture of "got to have it now" and "put your feelings out there," are we too impatient to demonstrate professionalism to our own residents and medical students? When we were in training, did we think what these young people now actually say?

Whatever our generational differences, our patients, the health-care system, licensing boards, and accreditation bodies hold all of us who are or aspire to be ob/gyns accountable for being "professional." Pursuing the characteristics I previously enumerated should be a high priority. The question is how we go about assessing the professionalism of someone who has different assumptions about what goes into those characteristics.