Σκέψεις γύρω από την έννοια του επαγγελματισμού.

[Argirios Argiriou]

  Πολλές φορές λέμε για κάποιον ότι είναι καλός επαγγελματίας αλλά αν το καλοσκεφτεί κανείς η λέξη επαγγελματισμός είναι μια αρκετά αόριστη έννοια. Τί είναι τελικά ο επαγγελματισμός;
Ποιά είναι τα χαρακτηριστικά εκείνα που βλέποντάς τα κανείς σε κάποιον λέει: Αυτός είναι Επαγγελματίας (με έψιλον κεφαλαίο..).

  Η ερώτηση αυτή με απασχόλησε ιδιαίτερα ίσως και λόγω της προσωπικής μου ιστορίας. Γεννήθηκα και μεγάλωσα στην Ελλάδα. Έφυγα όμως 19 ετών για την Σουηδία όπου και σπούδασα εκεί Ιατρική και μετά εργάστηκα σαν Ιατρός εκεί για άλλα 12 περίπου χρόνια πριν επιστρέψω στην Ελλάδα.
  Έβλεπα λοιπόν κάθε φορά που πηγαινοερχόμουνα μεταξύ των δύο αυτών χωρών μια διαφορά στον τρόπο που εργαζόντουσαν οι Σουηδοί, ανεξαρτήτως επαγγέλματος, σε σχέση με τους αντίστοιχους Έλληνες και κάθε φορά έλεγα: Οι Σουηδοί είναι πιο επαγγελματίες από τους Έλληνες. Γιατί όμως; Τί είναι αυτό που χαρακτηρίζει ένα επαγγελματία; Το ερώτημα έγινε πιο επιτακτικό για μένα όταν όντας εργαζόμενος σαν Γενικός Ιατρός στην πόλη Λίνκοπινκ της Σουηδίας μου προτείναν να συμμετέχω στην εκπαίδευση των πρωτοετών φοιτητών Ιατρικής της τοπικής Ιατρικής Σχολής και μάλιστα μου προτείναν να αναλάβω μια ομιλία με τον τίτλο: Τι είναι επαγγελματισμός.

  Σκέφτηκα από μέσα μου: Βρήκατε άνθρωπο, εμένα τον Έλληνα, να μιλήσει για επαγγελματισμό (να πώς γεννιούνται οι προκαταλήψεις ακόμη και για τον ίδιο μας τον εαυτό...). Παρόλα αυτά δέχτηκα και άρχισα να ψάχνω σε βιβλία, στο διαδίκτυο, να ρωτώ συναδέλφους που τους θεωρούσα καλούς επαγγελματίες, αλλά πάνω από όλα να ρωτώ τον ίδιο τον εαυτό μου: Ποιά χαρακτηριστικά είναι αυτά που βλέποντάς τα λέω για κάποιον ”Αυτός είναι καλός επαγγελματίας”.

  Προσωπικά νομίζω ότι η λέξη κλειδί είναι η λέξη Εμπιστοσύνη.

Όταν ο άλλος με τον τρόπο του δημιουργεί στον ”πελάτη” την αίσθηση της εμπιστοσύνης τότε για μένα είναι καλός επαγγελματίας. Είναι σχετικό ίσως το τί δημιουργεί εμπιστοσύνη στον καθένά μας. Εγώ πάντως κοιτάζω τα εξής πράγματα στον εργαζόμενο που με εξυπηρετεί:

Να είναι αποτελεσματικός και να παράγει ποιοτικό έργο.

Να είναι διαβασμένος και να φροντίζει να ενημερώνεται για τις νέες εξελίξεις στον τομέα του στην προσπάθεια μιας συνεχούς βελτίωσης του έργου του.

Να ακολουθεί κάποιους κανόνες και ηθικές αρχές.

Να ξέρει να βάζει όρια (πολλοί λένε ότι κάποιος είναι καλός γιατί δεν λέει ποτέ όχι. Αυτό όμως που μου έκανε εντύπωση κυρίως σε Σουηδούς που τους θεωρούσα καλούς επαγγελματίες ήταν ότι συχνά λέγαν όχι αλλά με τρόπο βέβαια που δεν πρόσβαλε τον άλλον...Ξέραν επίσης να προστατεύουν την προσωπική τους ζωή).

Να είναι προβλέψιμος.

Να έρχεται στην ώρα του.

Να καθησυχάζει με τον ήρεμο και σίγουρο τρόπο του και να έχει γενικότερα επικοινωνιακές δεξιότητες.

Να μη μιλά στον ”πελάτη” για προσωπικά προβλήματα ή στεναχώριες.

Να μη μιλά άσχημα για συναδέλφους.

Να προστατεύει την ιδιωτική ζωή / το απόρρητο, των ”πελατών” του.

Να δουλεύει με συστηματικό και δοκιμασμένο τρόπο. Τα περισσότερα πράγματα που πρέπει να κάνει κατά την διάρκεια της εργασιακής του ημέρας να του είναι γνωστά από πριν και να του φαίνονται εύκολα.

Όλα τα παραπάνω βέβαια απαιτούν και αρκετή δόση αυτοπειθαρχίας.

Το σπουδαιότερο όμως χαρακτηριστικό του κατά την γνώμη μου είναι να είναι ακριβολόγος. Να ξέρεις ότι όταν απαντά σε μια σου ερώτηση τότε γνωρίζει πραγματικά την απάντηση αλλιώς να λέει ”Δεν γνωρίζω” ή ”Δεν είμαι βέβαιος αλλά.....” Αυτό βέβαια προυποθέτει και μια ωριμότητα από την μεριά του ”πελάτη” ο οποίος αντιλαμβάνεται ότι όταν ένας εργαζόμενος λέει ”Δεν γνωρίζω” ή  ”Δεν είμαι βέβαιος αλλά..” δεν είναι δείγμα ότι αυτός ο εργαζόμενος είναι κακός επαγγελματίας αλλά μάλλον το αντίθετο.

Είναι ίσως ουτοπικό να περιμένουμε να βρούμε όλα τα παραπάνω χαρακτηριστικά σε έναν και τον αυτό εργαζόμενο αλλά όσο περισσότερα τέτοια χαρακτηριστικά βρίσκουμε τόσο το καλύτερο.

Θυμάμαι πάντως ακόμη μια ερώτηση που μου έκανε ένας φοιτητής μόλις ολοκλήρωσα μια ατελείωτη λίστα με χαρακτηριστικά ενός καλού επαγγελματία. Σήκωσε το χέρι και με ρώτησε: ”Εσύ είσαι καλός επαγγελματίας;”

Του απάντησα: ”Όχι, αλλά προσπαθώ.”

[Argirios Argiriou]

Book Review

Teaching Medical Professionalism.

N Engl J Med 2009; 360:2586-2587June 11, 2009DOI: 10.1056/NEJMbkrev0810795

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Αυτό που μου συγκράτησα περισσότερο:

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A strong theme that emerges in the book is the notion that professionalism — and the teaching of professionalism — is a team sport. The traditional myth of the insular relationship between physician and patient has given way to a much more complex array of relationships among patients, nurses, allied health professionals, laboratory technicians, and others. To focus only on the professionalism of physicians is not enough. Every member of a patient's health care team must be committed to professionalism

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[Argirios Argiriou]

Professionalism: A commitment to lifelong learning aimed at the care of the patient

Martin Samuels, MD | Physician | January 23, 2015

Ι am a doctor today because of Dr. J.W. Epstein, my pediatrician in Cleveland in the 1950s. An immigrant from the Nazi terror in Europe (it was family lore that he had escaped the Holocaust), he had trained in Vienna and spoke English with a Germanic accent. His house calls are etched permanently in my memory. His visits were heralded by a fury of activity, led by my mother. “The doctor is coming! Put on clean underwear. Clean the house.” Water would be set to boil on the stove, in case the doctor should need to sterilize a needle for an injection.

Up would drive his broken-down jalopy, which he would park directly in front of the house. No need to worry about getting a ticket. The police knew his car and would never issue a citation to The Doctor. No one — not the mayor, not the governor, not even Al Rosen, the venerated third baseman for the Indians — would have received such a royal welcome.

In he would come, wearing a suit and hat, carrying a worn black doctor’s bag. “Mudder, ver is da boy?”

“He’s in his room upstairs with a rash and sore throat.”

He would put down his bag, sit on my bed, and ask me if the teacher had sent home the homework. He wouldn’t want me falling behind in my school work. That might interfere with my becoming a doctor.

Then came the ritual of the examination. Say aah; schtick out your tongue; take some deep breaths. “Gut … gut … zounds normal” as he listened with his stethoscope, feeling gently on my belly and then finally tap on some reflexes with his tomahawk hammer. “Mudder, it’s da measles, plenty of fluids, back to school in a few days. Veel zee you in da office next fall for da usual checkup. Mudder; don’t vorry, it isn’t polio.” No time for a cup of tea today; too many other house calls for this afternoon and off he would go. The enormous feeling of relief, transmitted from my mother to me, had me on the mend in no time.

This is what I wanted to do: Be the agent of relief, the repository of medical knowledge, the most respected figure in the community. Some years later, as a teenager, I was waiting in Dr. Epstein’s office for my annual checkup before school started in September. I was surrounded by little babies, and I realized that I might be growing out of Dr. Epstein. As he was tapping on my back in the usual reassuring fashion, I said to him, “How long can you see me as a patient?”

“Until you’re a doctor.” How could I fail him?

I cannot tell you how often I think of J.W. Epstein as I practice neurology. When I look in the eyes of an anxious headachey patient with my ophthalmoscope, I mumble, barely audibly in the patient’s ear, “Looks fine, looks normal. I’m looking right at your brain. It’s not a brain tumor.” The therapy has begun. Sometimes, of course, the news is not so good, but even then I can reassure my patients that they can count on me, that I will not abandon them, and that we can take care of them, no matter what the situation demands. Even death itself is part of the physician’s portfolio.

As health care reform occurs, perhaps this can be the opportunity to recapture the spirit of Dr. J.W. Epstein. Professionalism is not a politically correct online course in cultural sensitivity. It is not shift work with decision support systems. It is not an electronic medical record or e-prescribing. It is not capitation or bundled payments. It is the commitment to lifelong learning aimed at the care of the patient. If we can help our patients to believe in their doctor’s motivations, knowledge, and commitment, we would not only save a lot of money, but we would also all feel a lot better.


Martin Samuels is a neurologist.  This article originally appeared on The Doctor Blog and Forbes.com.

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[Argirios Argiriou]

10/09/2915

I started singing in the procedure room. And it reshaped my view of professionalism..

CHIDUZIE MADUBATA, MD | PHYSICIAN

In medical training, one of the main things that is emphasized is the importance of acting professionally. We encounter patients who have a particular idea of how doctors are supposed to act during the patient-physician encounter, and for the most part, I expected that they would want a doctor who is caring, but serious, at the same time.

In those encounters, we are focusing on the health of patients, a very serious concern in their minds and what should be a serious concern for us as well. We deal with talking to patients about making important decisions regarding their health, decisions that may involve treatments or procedures that could potentially lead to untoward side effects. For the most part, I approached most of my encounters with a sense of gravity about the patient’s medical situation, but I recently had a patient that caused me to do something that challenged my ideas of what being professional could potentially look like in the hospital.

I recently was involved in the care of a patient who had to be admitted because of an abnormal finding on an ultrasound of her heart. She was a pleasant lady who had come in for a routine outpatient echocardiogram because she was having increasing trouble breathing. She had just finished receiving treatment for breast cancer, and given her worsening shortness of breath, an echocardiogram was ordered to evaluate her heart function.

When the images were analyzed, there was concern about a density in one of the chambers of her heart. It was unclear if there was a clot on her port which may have traveled to her lungs or if there was a mass in her heart that would raise concern for possible spread of her cancer. Since it was an unclear picture, she was told that she would be admitted so that another procedure could be done to get better images of her heart. She understood the reasoning behind the admission, and she agreed to be admitted.

During her hospitalization, other consulting services became involved to determine how to further evaluate this density in her heart. At one point, she needed to be on a blood thinner before it was determined that there was no clot in her lungs that was causing her symptoms. There were also debates about whether to remove her port to see if that could explain the density, but there was concern that with removal of the port, there might be a clot attached to it which could dislodge and potentially cause other problems. Given these ongoing discussions, her planned procedure was delayed for a few days.

I would expect that a delay like this would cause patients to become frustrated and impatient, but not so with her. She was so patient and kind to the staff taking care of her, appreciative of the care that she was receiving. She trusted all of us with regards to her care, and always said “Thank you” any time a physician would stop by to give her an update. She had a kind and gentle spirit, the type of personality that would soften even the hardest personality types. By the end of her hospitalization, she won the hearts of many, and it was her personality that led us to do something unconventional.

After a few days of discussion, it was decided that the procedure would go on after all. The procedure was going to be a transesophageal echocardiogram, which involves passing an ultrasound probe down the esophagus to just behind the heart in order to take images while the patient is consciously sedated. I was scheduled to do the procedure with the help of a cardiologist by my side. When she arrived in the procedure room, she was still in good spirits but was a little nervous about the procedure. The anxiety had two parts: she was not sure what she would feel during the procedure, and she was worried that what we found during this procedure could possibly indicate a progression of her breast cancer. Even with all this, she was chatting away with the rest of the staff in the room and causing everyone to be in good spirits. Like I said before, she had an amazing personality that was infectious to everyone who came into contact with her.

Just before the procedure, she was chatting with the nurse anesthetist and soon the topic of her favorite music came up. It turns out that both of them were fans of Motown music, and they started talking about some of the songs that they enjoyed. Admittedly, my ears perked up since I knew some of the songs they were discussing, songs that I grew up listening to. It turned out that the other staff in the room were also familiar with Motown music and listened in to the conversation. As the conversation came to a close, she started singing a few bars of the Temptations’ hit, “My Girl,” with the nurse anesthetist. Then, all of a sudden, I did something that I never thought I would do in a million years: I started singing in the procedure room.

Let me repeat: I started singing in the procedure room.

What happened was that they started singing one of my favorite Motown hits, and I immediately saw a change in her countenance. She no longer felt afraid because she was just having fun with this nurse anesthetist singing one of her favorite tunes. I saw that this had a therapeutic effect on her, and that in the midst of everything, she dealt with her nerves by singing. I thought that if anything, I could help her out further by joining in, so I started singing a few bars of “My Girl” with her. What surprised me was that pretty soon, everyone else in the room joined in, and suddenly we had an impromptu a cappella group in the procedure room for about a minute or so. Everyone was having a good time because of this wonderful patient, and we almost started dancing like the Temptations before we finished. (One of the doctors alleges that I did dance a little bit; maybe I did since I was having such a good time). Once we finished singing, I went ahead and did the procedure with the cardiologist, and thankfully that density turned out to be a Eustachian ridge, a very benign finding. Given these findings, she was discharged later that day.

What I learned that day was that for this patient, being professional meant acknowledging the anxiety she had about her medical situation in that period of time, and that there was a particular way in which she coped with the anxiety that helped her successfully go through the procedure. For her, singing was her coping mechanism, and she was looking for us to come alongside her and support her in this practice. I never thought that singing in the procedure room would ever be something that I would consider to be professional, but I saw that singing a few bars had a therapeutic effect on her the second another health professional started singing with her.

There was a brief period of hesitation on my part since it went against my previous assumption of professionalism as only being manifested in a doctor being serious in these moments, but I realized that even in singing, it was all about the patient and how she was feeling first and foremost. Perhaps that is what professionalism is ultimately about, that our outward actions are a reflection of us putting the patient first as opposed to us focusing on how those actions look in and of themselves.

For the longest time, I thought professionalism was all about how I should act, and that still is an important part, but I now think that the thing that trumps even those actions is making the patients the priority. If that causes us to act differently than what is expected for an ultimately therapeutic effect on a patient, then so be it. At the end of the day, that patient will remember how she felt in her time of need, and she will remember the staff that sang with her to put her at ease. I am not promising that I will sing again in the procedure room anytime soon, but at least I will remember this moment to remind me that sometimes, I may need to act in unconventional ways to help patients feel that they are in good hands. At the end of the day, even singing along with patients in that context can be seen as a professional act.

Chiduzie Madubata is a cardiology fellow.