Prepared by Ghazi Rayan, MD
Ethical practice and professional conduct are of paramount importance to physicians of all specialties including Hand Surgeons. Professionalism is the basis of medicine’s contract with society. It demands placing the interests of patients above those of the physician. It requires establishing and maintaining standards of competence and integrity, and providing authoritative guidance to society about matters of health. The doctrine and responsibilities of medical professionalism should be comprehended by both the profession and society. Fundamental to this contract is public trust in physicians, which is dependent on the integrity of both physicians and the profession.
Adherence to professionalism is being promoted at many levels of the Medical field. As part of Competency-Based Educational Objectives, Medical Students and Residents in training are expected to develop professionalism manifested by a commitment to carrying out professional responsibilities with adherence to ethical principles. Specialty societies including the ASSH have a responsibility and important role in advancing ethical conduct among physicians in practice and address the concerns of public and members of those societies about newly emerging ethical challenges of practicing medicine today.
Ethics is a discipline that deals with principles and standards of human conduct or moral values that govern relationships between and among individuals. Paul Starr defined Profession as “an occupation that regulates itself through systemic required training and collegial discipline… that has service rather than profit orientation enshrined in its code of ethics.” (The social transformation of medicine). Medical Professionalism is characterized by behavior recognizing the primacy of the patient’s welfare, including both physical and psychosocial aspects of disease. The decision-making process is informed solely by the welfare of the patient and the tenor of the interaction is courteous, respectful and sensitive to the stress associated with illness and the patient’s ability to understand. Professionalism also implies a commitment to continued learning and improvement and acknowledgment when one’s skills or capabilities interfere with rendering the best possible care to the patient. Professionalism requires the practitioner’s distinction in the following areas; altruism, accountability, excellence, duty, honor, integrity and respect for others.
Professionalism is one of 6 core competencies identified by the American Board of Medical Specialties (ABMS) that describe a competent physician and these include:
- Medical Knowledge
- Patient Care
- Practice Based Learning and Improvement
- Systems Based Practice
- Interpersonal and Communications Skills
Professionalism is one of 4 core competencies for the Maintenance of Certification (MOC) that were adopted by the Specialty Boards and are required for board certification. These are:
- Evidence of professional standing
- Evidence of cognitive knowledge
- Evidence of performance in practice
- Commitment to life long learning and self assessment
- Concerns about patient welfare and physicians’ behavior were part of the Code of Hammurabi (2000 BC).
- Oath of Hippocrates (400 BC) is a statement of principles and ideals to be respected and used by physicians.
- Thomas Percival was a British physician and philosopher who in 1803 published the “Code of Medical Ethics” which became the corner stone of modern code of ethics.
- In 1847 the AMA adopted Percival’s “Code of Medical Ethics” as its code.
- In the last 50 years surgical organizations associated with the ASSH established enforceable codes of ethics including the ACS, ASPS and AAOS. The AAOS’ 1988 code of ethics and subsequent inclusion of Professional Compliance Program with its Standards of Professionalism (SOP) took over five years to develop.
- In response to members’ inquires the ASSH in 2004 provisionally adopted the statement of professionalism put together by three internal medicine organizations (ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine).
- During the May 2007 Council meeting in Greensboro Georgia, Dr Steve Glickel impaneled a Task Force (TF) to study the possibility of developing a Code of Ethics for the purpose of delineating standards for the ethical practice of Hand Surgery and enhancing the message of professionalism among the members of the ASSH. The composition of the TF included the following members:
- Steven Glickel, MD (President ASSH)
- Ghazi Rayan, MD (Chair)
- David Lichtman, MD
- Murray Goodman MD
- Charles Carrol MD
- Michael Hausman, MD
- Alex Y. Shin, MD
- L. Scott Kozin, MD
- Richard Idler, MD
- Dawn Briskey, CAE (Liaison)
The Task Force on Ethics and Professionalism produced a document that was presented at the December 2007 Council Meeting recommending that the ASSH should:
- Advance, enhance and promote ethical conduct and professional behavior among its members.
- Develop and adopt an aspirational “Code of Ethics and Professionalism” of its own
- Consider the establishment of series of “Position Statements” separate from the Code about a variety of ethical and professional issues
- Establish a comprehensive “Ethics and Professionalism Educational Program”
- Promote professionalism early in a Hand surgeon’s career targeted towards new members.
- Consider the establishment of a standing “Professionalism Committee” within the new governance structure of the ASSH.
Pursuant to approval of these recommendations by Council, the Task Force was charged with generating the ASSH Code of Ethics and Professionalism. After a lengthy and careful deliberation the Task Force produced the new Code with its 13 clauses which was approved by Council during its spring meeting on May 2008 in West Point NY. Shortly thereafter a standing committee on Ethics and Professionalism was established with the following members:
- Ghazi Rayan, MD Chair
- Steven Glickel, MD
- David Lichtman, MD
- Murray Goodman, MD
- Charles Carroll, MD
- Jeanne Del Signore, MD
- Steve Peterson, MD
- Loree Kallianen, MD
- Nash Naam, MD
- Dan Zlotolow, MD
- Dawn Briskey, CAE Liaison
This committee has been hard at work fulfilling its mission which includes; supporting the Code of Ethics and Professionalism, promoting ethical conduct and professional behavior among Hand Surgeons, educating new and established members about ethical issues and developing a comprehensive “Ethics and Professionalism Program” that fosters and advances ethical principles and professionalism among members of the ASSH.