Professionalism in Medicine

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??? ???? ??????? ???????Professionalism in
Medicine ???? ???? ?? ???????

• ????? ?????? ????? ?????
• 11 ????? ??? 1387????? 31 ?????? 2008
• Moslem Bahadori MD,FCCP

2
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• ?? ????? ???????? ??????? ???? ?
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  ?????? ?? ???? ????? ??? ? ??? ???? ??????? ???.

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• ???? ????? ?? ??? ???? ?????????? ?????? ???? ??
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• ???? ????? ? ????? ?? ??? ????? ????????? ??? ?
  ???? ? ?????? ?????? ????? ???. ??? ???? ???? ???
  ???? ???? ?? ?????? ?? ???? ???
• ?? ??? ????? ?? ???? ? ?? ???? ? ?? ????? ???????
  ??? ?? ?? ????? ????? ????????? ?? ???? ????
  ????? ?????? ?? ?????? ????? ?? ?? ?? ??? ?????

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????? ???????????

• ?? ???? ? ??? ???? ??????????? ????? ??????? ??
• EXPERTISE ( Exclusively body of knowledge and
  skills)
• ETHICS ( A combination of values and
  standards)
• SERVICE ( Vocational commitment to put
  patients first)

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WHAT IS MEDICAL PROFESSIONALISM

• ???????????? ???? ????? ????? ?? ???????
  ?????? ??????? ??????? ?? ??????? ???? ???? -
  ????? ??? ?? ????? ?? ????? ?? ?????? ?? ????
  ???????.

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??????

• ?????? ?? ??? ????? ???? ??? ???? ????.
• A profession
• is an occupation that regulates itself through
  systematic, required training and collegial
  discipline, that has a base in technical,
  specialized knowledge, and, that has a service
  rather than profit operation enshrined in its
  CODE of ethics
• Sox H C. Chest 20071311532-1540

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????? ????-???? ???? ?? Professionalism

• According to Webster New Collegiate
  Dictionary, Professionalism means
• The conduct, aim or qualities that characterize
  or mark a profession or professional person
• All professionals share common characteristics
  such as
• Self-governance ?????? ?? ???
• Life-long learning????? ?????
• Fiduciary ???? ?????? ????
• Responsibilities ??????? ?????
• And most of all a CODE to abide by

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a CODE to abide by

• ???- ?????? ???? ????? ????? ??????? ????ALTRUISM
• ? ??????? ???? ???????????? ???? ???? ????? ?
  ?????? ????
• ? ????? ?????? ??????? ?? ??? ????? ??? ???????
• ? ????? ??? ????????? ?? ????? ?? ???????
  ???????
• Providing expert advice to society
• on matter of health

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Code to abide

• Hippocrates
• With purity and with holiness, I will pass my
  life and practice my ART.
• The Islamic Code
• Health is a basic human necessity and not a
  luxury. A patient should not be denied services
  even if she/he can not afford the fee

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Code to abide

• Charaka Samhita( Indian Code)
• He who practices not for money nor for caprice
  but out of compassion for living beings (Bhuta-
  daya), is the best among all physicians.
• Sun Simiao ( Chinese Oath)
• Physician to develop first a sense of compassion
  and piety, and then to make a commitment to try
  to save every living creature, to treat every
  patient on equal grounds and to avoid seeking
  wealth because of his expertise.

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• ?????? ????? ??????
• ????? ?? ???? ? ????? ??? ?? ?? ?????.
• Medicine is a CALLING, not a BUSINESS.
• ????? ????? ????? ??? ?? ???? ????? ?? ???
  ????? ??? ?? ?? ????? ?? ???? ????.
• ??? ???? ? ????? ?? ????? ??????? ???.

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??? ????

• ???? ???????? ?? ??? ????? ??? ?? ??? ?????
  ???? ????? ???? ????? ??????
• ???? ??? ???????? ??? ?? ??????? ?? ?????? ?????
  ???? ???? ???? ????? ?? ?? ?????? ?????
• ??? ?????? ????? ???? ???? ??????? ?? ??? ??
  ???? ?? ???? ? ?????? ???? ????? ???
• ??? ???? ???? ??? ?? ?? ?????? ??????? ?? ?????

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• ??? ????? ?????? ?? ?? ???? ?????? ??? ?????? ??
  ????? ???? ???? ???
• ???? ???? ???? ???? ??????? ????? ??????
  ????????? ??? ????? ????? ?? ??? ??? ?? ????? ???
  ?????
• ???? ?? ????? ??????? ???? ????? ?? ???? ???
  ?????? ?? ??????? ????? ?? ????? ?????? ?????
  ????? ????? ???? ?????.
• ????? ?? ????? ??? ????? ALTRUISM ?? ???? ?????
  ??????
• He/She is so professional, worthy to serve the
  suffering

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??????????? ?? ??? ????

• ??????? ?????? ??????? ????? ????? ??? ??
  ?????? ?? ?????? ???? ????? ?? ????? ?????
  ??????? ?? ??? ?? ???? ?? ?????? ?? ???????
  ?????? ???? ????? ????? ??????????? ??????.
• ?????? ??? ????? ?? ?? ?? ???? ????? ????? ??
  ??? ???? ? ??? ???????? ????? ?? ??????? ?
  ???????? ????? ?? ?????? ?? ????? ????? ??????
  ????? ???.

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????? ???? ???? ???????????

• ?? ???? ??????? ???????? ?? ?????? ??
  ????? ?????? ????? ????? ???? ?? ????? ????? ???
  ??? ??? ??? ??? ??????? ???.
• ???? ???? ??? ?? ????? ??? ??? ?? ????
• ?????? ?????? ????? ???????? ???? ???
  ????? ???? ???? ???. ??? ??? ??????? ?? ???????
  ?? ??? ??? ???? ??????.
• Their judgment is subject to an unconscious
  and unintentional self serving bias.
• ???????? ???? ?????? ??? ????? ????? ???? ???
  ??????? ????? ??? ?????? ???.
• .

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• ?????? ?? ??????? ?????? ???? ?? ?? ?? ?? ???
  ???? ???? ????? ??? ??? ???? ????? ?????????
  ????? ? ????? ????? ?? ???? ?? ????? ???? ?????
  ?????? ?? ???? ?????? ? ???? ??? ?? ????? ???????
  ?? ??? ???? ??? ???. Being ones own boss
• ????? ???? ?? ?? ??? ????? ??? ? ?????? ????
  ?? ???? ????? ???? ???? ????? ?????? ??? (
  ?????????? ) ??? ? ?????? ?? ???? ???? ????
  ???.

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Professionalism vs commercialism

• Professionalism
• Doctor
• Patient
• Trust
• Caring
• Services
• Values
• Cures
• Pride

• commercialism
• Provider
• Customer
• Suspicion
• Pandering
• Commodities
• Margins
• Profits
• Bonuses

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????? ?? ?????? ?? ?????? ????????? ?????

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  ???? ???.
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  ? ????? ??????? ????? ???? ?? ???? ????? ??? ??
  ??????? ???? ?? ????? ?????.

20
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  ????? ?????
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• ?? ??? ????? ???? ???? ?? ?? ?? ??? ???????
  ???? ?????? ??? ?? ??? ???? ??????? ??
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  ?????.
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22
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• ??? ????? ????? ? ????? ????? ?? ??? ?? ???
  ??? ???.
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  ?? ???? ????.

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????? ??????????? ?????

• ?? ?? ????? ?? ???????? ??????? ?????????
  ?????? ???? ???????? ?????? ? ????? ?????? ?????
  ?????? ?? ABIM
• ( American Board of Internal Medicine )
• ????? ????? ?? ??? ??? ???? ??. ??? ?? ?? ??
  ???? ??????? ? ?????? ????? ???? ???? ????? ? ??
  ???????? ?? ????? ????

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????? ?????Physician Charter

• ?? ??? ?????? ?? ????? ?? ???? ???? ???? ???
• ??? ???? ??????? Fundamental Principles
• ? ?????? ?? ?? ?????????? ????????
• A set of professional responsibilities

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???? ???????

• A - Principle of primacy of patients welfare
• -??? ?????? ?? ????? ?????
• B - Principle of patients autonomy
• -??? ????????? ?????
• C -Principle of social justice
• -??? ????? ???????

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?????????? ????????COMMITMENTS

• Commitment to professional competence
• Commitment to honesty with patients
• Commitment to patients confidentiality
• C. to maintaining appropriate relationship
• C. to improving quality of care
• C. to improving access to care
• C. to a just distribution of finite resources

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• C. to scientific knowledge
• C. to maintaining trust by managing
• conflicts of interest
• C. to professional responsibilities
• .

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• ?? ?? ?? ?? ?? ????? ????? ?? ??????? ?????
  ?? ???? ?????? ???? ???? ????? ??? ????? ????.
  ??? ????? ????? ????? ? ????? ????? ???? ?? ???
  ???? ??? ???? ????.

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????? ??????????? ?? ???? ???????

• ?? ???? ?????? ?????? ???? ??????? ???????
  ??????????? ????? ??? ???. ???? ?????? ????????
• ???? ?????? ????? ???????? ????? ????? ????????
• ? ???? ??? ????? ????? ?? ??????? ??????????
  ???? ????? ???? ??? ?? ????? ???? ????? ????? ?
  ?????? ???.
• ????? ?????? ???? ???? ????? ?????? ACGME?
  ???? ???? ???????? ?????? ??? ?????? ?? ?????? ??
  ??????????? ??? ???? ???? ??? ?? ?? ?? ????????
  ????? ?????? ? ?? ?? ?????? ???? ???? ??? ?????
  ????? ????? ????.

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????? ???????

• ?? ??? ?????? ?????? ????? ?? ??????
• Demonstrate a commitment to carrying out
  professional responsibilities and adherence to
  ethical principles.
• ?? ???? ?????? ???? ?????? ???? ?? ?? ??
  ?????? ??? ???????? ???? ????? ? ???? ???????
  ??????? ????.
• ?? ??????? ?? ?????? ????? ??????? ????? ??
  ??????? ??
• OSCE, MCQ, and subjective assessment by peer or
  by supervising faculty
• ?????? ? ???? ???? ????

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• Conflict of interest
• Collegial and interpersonal interaction
• Honesty
• Dutifulness
• Reporting / recognizing medical error
• Resident exposure to high risk materials and
  patients

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??????????? ??????? ?????

• Expert consultation
• Education/advancing knowledge
• Confidentiality/Privacy
• Compliance/ Billing/Coding
• Human Experimentation
• Guild Adherence

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?????? ????????????

• ??? ?????? ?????????? ?? ??? ???????????
• 1 _ ??? ???? ? ????? ?????? ?????? ???????
  ?????
• 2 _ ????? ? ????? ?????? ?????? ???? ???? ??
  ??? ??????
• 3 _ ??? ???? ???? ????? ( ????? ????? ???????
  ) ?? ????? ??? ???? ???? ??
• nonprofessionalism

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39
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• ?? ???? ????? ???? ?? ???? ????? ?????? ?????
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• ?? ???? ???? ???? ?? ?? ???? Role Model ?? ?????
  ??? ?????
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  ???????
• ?? ????? ????? ???? ???? ???? ??? ?? ?? ??????
• ?? ????????? ????????? Perpetual student ???????
  ??? ????? ??????? ?? ??? ????
• ?? ???? Health Care System ?? ???? ???? ??? ????
  ??????? ???? ????? ??????? ?? ??????? ??? ????
  ????? ????

41
????

• ?? ????? ??? ???? ?? ???? ? ????? ???
• ?? ???? ?????? ??????? ????? ?? ?? ???? ?? ??
  Medical Professionalism ??? ??? ??? ???? ???????
• ???? ??????