Lecturer calls for open conversation about professionalism

Thomas M. Scalea, MD, FACS, MCCM
Thomas M. Scalea, MD, FACS, MCCM

Professionalism is the cornerstone of medical practice, yet there is no generally accepted definition of professional conduct, according to Thomas M. Scalea, MD, FACS, MCCM, the Honorable Francis X. Kelly Distinguished Professor in Trauma Surgery, University of Maryland School of Medicine, Baltimore.

Different generations, institutions, and individuals have their own ideas about what does and does not constitute professional behavior, said Dr. Scalea, adding that medical professionals desperately need to talk openly about acceptable behavior.

“The single most important factor in delivering the best clinical care is our behavior—how we interact with each other and with our patients,” said Dr. Scalea, who also is physician-in-chief, R Adams Cowley Shock Trauma Center, and system chief for critical care services, University of Maryland Health System. “I have my idea about professionalism, but I’m not sure that jibes with other people’s concept. We need an open, honest, and clear conversation around professionalism.”

Dr. Scalea will deliver Tuesday’s annual Scudder Oration on Trauma. His lecture, Homeward Bound, will explore the evolution of professionalism during his career as a renowned surgeon.

“The concept of professionalism has changed remarkably during my career,” he said. “When I was in training, the need to be professional, particularly for highly placed surgeons, was not even on the radar screen. As a resident, we were abused every day by today’s standards. Behaviors in the operating room—screaming, throwing instruments, even hitting people—were completely tolerated. The chief of surgery was king—it was always a male—and nobody questioned his authority or behavior. We do not allow that to happen today.”

This behavior was simply part of training in the past, and—for better or for worse—it made surgeons different from other clinicians, Dr. Scalea said. However, it also taught residents to behave in ways that should have been unacceptable then and are clearly not tolerated today, he acknowledged.

“There has been an explosion of concerns about professional behavior, which is good. But the adjudication of those concerns leaves something to be desired,” said Dr. Scalea, adding that the tone for professional behavior must start at the top. But part of the problem is not wanting to talk about the obvious when someone, whether a colleague or a superior, behaves in a way that seems inappropriate.

“What we need is a way for people to make their feelings known—a way to convey the message that what you did made someone uncomfortable or unhappy,” he said. “We need a conversation around professionalism that starts with our clinical leaders, but involves everybody.”

The Scudder Oration on Trauma Lecture honors Charles Locke Scudder, a founding member of the American College of Surgeons and a major contributor to the surgery of trauma.