Academy raising emphasis on ethics, professionalism

Mary Maloney, MD, (right):” “Professionalism and ethics go far beyond a written statement.”

Mary Maloney, MD, (right): “Professionalism and ethics go far beyond a written statement.” Maria Hordinsky, MD, is on the left.

Staying up to date on the continuously evolving standards of ethical and professional behavior is as important in medicine as staying updated on science and practice issues, a point emphasized during Friday’s Plenary presentation, “Professionalism: Opportunities and Dilemmas in Dermatology.”

“Professionalism and ethics go far beyond a written statement. We need to return to having enthusiasm for this as a topic of discussion on a ongoing basis,” said Mary Maloney, MD. “I don’t see any end to discussing this because if we are not doing well, we have to discuss it. If we are doing great, we need to give ourselves the credit, and then discuss it all the more.”

Dr. Maloney and Maria Hordinsky, MD, addressed the challenges of ethical behavior during their Plenary presentation and in a separate exclusive interview with AAD Meeting News. Both are members of the AAD Professionalism and Ethics Committee, which is working with the Academy staff to develop resources related to professional behavior for AAD members.

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Dr. Hordinsky: “Our goal is to transfer professionalism from passive documents to visible action by members of our organization.”

“Our goal is to transfer professionalism from passive documents to visible action by members of our organization,” Dr. Hordinsky said. “JAMA recently had an issue devoted to professionalism and how the medical profession in the United States polices itself. If we don’t do a good job of this, someone else is going to do it for us.”

During the Plenary presentation, Drs. Maloney and Hordinsky presented scenarios where attendees used an audience response system to choose best reactions to ethical and professional dilemmas. Still, they made it clear that the presentation is only part of what needs to be an ongoing discussion, and that often there are many answers, not just one answer, when ethics questions arise.

“We are hopeful this will not be a once-and-done topic at a plenary session,” Dr. Maloney said. “We hope this will be a topic that will be presented frequently and that members will look forward to the discussion not as something painful, but as something that can be educational, fun, and entertaining.

“What we are trying to do is start the dialogue and not have anyone feeling that there is always one right answer. For example, if you talk about professionalism in clothing, what is the right answer? How do you define that? You need to have that kind of a dialogue rather than, ‘Here is what a professional looks like.’”

Professional and ethical dilemmas also have been addressed in recent recurring articles in the Journal of the American Academy of Dermatology (JAAD). The emphasis is important because many dermatologists are in solo or small practices where they may not have access to those dialogues with colleagues. Younger dermatologists also may not have that experience.

“The topics have been excellent,” Dr. Hordinsky said. “You can easily spend an hour discussing any of the topics addressed in those articles. They are related to curbside consults, using photography, sending photos on your phone … common scenarios in the life of being a dermatologist.

“There are a lot of people, especially young graduates, who are now going into large organizations where there are ethics committees and professionalism is expected. People are taking a look at how physicians practice. They may not be physicians looking at physicians, rather administrators looking at physicians, with physicians on those committees.”

The emphasis on professionalism also is important as multidisciplinary treatment of patients becomes more common. Dermatologists increasingly are interacting with physicians or health care professionals from other specialties.

“There was a survey of people outside of dermatology a few years ago about what they thought of dermatologists. It was not glowing,” Dr. Maloney said. “These were some of our colleagues in other medical societies. It seemed they thought we had gone into dermatology because you worked less, you got a lot of pay, and the hours were great.

“Some of it rang a little true in that there are some areas where dermatologists don’t do inpatient hospital consultations. There have been studies that if you call for a cosmetic appointment, you can be seen in 48 hours, but if you call for a changing mole, it is three to six weeks. These are some of the things we are trying to battle.”

Goals of the Professionalism and Ethics Committee include developing a pledge for AAD members to sign, and posting online education modules and a resource center on the Academy website. Also, four articles about ethics and professionalism will be developed for publication in JAAD.

Dr. Maloney said positive change involves self-awareness and continued dialogue.

“Trainees and even people who have been practicing for a while need to just be thinking and be aware of these scenarios because some of them are ethical topics,” Dr. Hordinsky said. “They are not straightforward and there are not black-and-white answers. Going back to the Hippocratic Oath, you are there to treat people and do it right. Times change, but our core values should not.”

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