Cover 1
Half-title 3
Title 5
Copyright 6
Contents 7
Contributors 8
Preface 11
1 Introduction: Experts and expertise 13
References 18
2 Globalization 19
Editors\u2019 introduction 19
Introduction 19
Decivilization 20
The changes of the middle class 21
Commoditification 21
Reduction of the social capital 22
Migration and population movements 23
The technological revolution 23
Obsolescence of social service strategies 24
Changing relations between countries 25
Socio-demographic changes 25
Importation of value systems 26
Coda 27
References 28
3 The virtues and vices of professionalism 29
Editors\u2019 introduction 29
Introduction 29
Translating professionalism into law 31
Clinical freedom: a negative or positive right? 33
Clinical freedom in UK mental health legislation 35
The development of a new professionalism 37
The structure of professional employment in the NHS 37
Conclusions 40
References 42
4 Professionalism: The US perspective 44
Editors\u2019 introduction 44
Introduction 44
The relationship of the medical profession with society 45
The first definition of a medical professional 46
Change in organized medicine and its impact on professionalism 47
The AMA and the Flexner Report 1910 47
American medicine after the Flexner Report: the rise of specialization and the profession\u2019s response 48
State medical societies or associations 49
Practitioners and medical societies 49
Specialization and specialty societies 50
Subspecialization 50
Special issues in psychiatry 51
The impact of the shifting role of federal government and changing societal concerns on medical professionalism 51
Overview 52
Areas of interaction between society and medicine 52
War and physician shortage 52
Healthcare payment systems 53
Federal healthcare systems 54
Issues in the cost of healthcare 55
Quality healthcare and the Institute of Medicine 56
Consumers and providers 57
Professionalism in 2010 and beyond 57
Training new American doctors in professionalism in the early twenty-first century 58
Conclusions 58
References 59
5 Professionalism: The UK perspective 60
Editors\u2019 introduction 60
Introduction 60
What is medical professionalism? 61
The evolution of medical professionalism in the UK 62
Earlier times: 1858\u20131989 63
Out with the old, in with the new: 1990\u20132009 64
The new professionalism 65
Collective professionalism 66
Professionalism at the workplace 67
Medical education and professionalism 67
Recognition and use of the power of modelling 68
Involvement of patients in teaching and assessment 69
Attention to the dilemmas faced by those early in their careers 69
Explicit assessment of professionalism 70
Continuing professional development 70
Conclusions and challenges 70
References 72
6 Professionalism and resource-poor settings: Redefining psychiatry in the context of global mental health 74
Editors\u2019 introduction 74
The treatment gap in mental health 74
Barriers to closing the treatment gap 76
Rethinking the professional role of mental health specialists 77
Supporting mental healthcare programmes 77
Carrying out priority research 78
Building capacity 78
Advocacy 79
Implications for professionalism in low-resource settings 79
Training of mental health specialists 79
Job profiles of mental health specialists 80
Conclusions 80
References 81
7 Professionalism: Australian perspectives 82
Editors\u2019 introduction 82
The Australian context 82
Professionalism and psychiatry 84
Professionalism, psychiatry and intimacy 84
Professionalism, psychiatry and power imbalances 85
Planning for professionalism in Australian psychiatry 85
Standards of professional conduct 85
Promoting professionalism in Australian psychiatry 87
Selection to medical school 87
Within medical schools 88
Selection for psychiatry training 89
Teaching within psychiatry training 89
Post-Fellowship requirements for continuing medical education 90
Regulating professional conduct 90
Conclusions 91
Postscript 91
References 92
8 Can professionalism be taught? Lessons for undergraduate medical education 94
Editors\u2019 introduction 94
Introduction 94
What does it mean to teach professionalism? 95
Proposed strategies to teach professionalism 96
Effectiveness of interventions to teach/improve professionalism 97
Evidence of ability to identify or predict unprofessional behaviour 98
Summary: can professionalism be taught? 101
References 102
9 Patient expectations from psychiatrists 104
Editors\u2019 introduction 104
Introduction 104
Review 105
Patient and carer expectations 107
Being knowledgeable 107
Being honest and approachable 108
Healing 108
Being ethical 108
Emotional intelligence 108
Communicating 109
Sharing information 109
Being paternalistic 109
Characteristics of a good psychiatrist 111
Conclusions 111
References 112
10 Teams and professionalism 113
Editors\u2019 introduction 113
Introduction 113
The challenges of professionalism 114
The beginning of professionalism: a medical student's first 'team\u2019 115
In the presence of the cadaver 115
The natural history of medical student cynicism 116
Professions and the ascent of professionalism 117
What is a profession? 117
Collaboration: the new practice paradigm 118
The nature of teams 119
What constitutes a well-functioning team? 119
Work groups versus teams 119
The way teams function 120
Team processes 120
Why teams fail 121
CRM: the essence of teamwork 121
The role of simulation in teaching teamwork 122
The integration of professionalism and teamwork 122
How to be a good team member 122
Self-health: another role for teams in healthcare 123
References 124
11 New professionalism 127
Editors\u2019 introduction 127
Introduction 127
The practice of professionalism 128
Professionalism values 129
Frameworks of professionalism 131
Governing council frameworks 131
Priester's framework of healthcare values 132
Professionalism in a new century 134
New professional relationships 134
Professionalism and society 134
The new professionalism framework 135
References 137
12 Medical professionalism in the new century: Accomplishments and challenges in the future for an American medical school 139
Editors\u2019 introduction 139
Introduction 139
Background 140
History of professionalism 140
Professionalism and/or versus humanism? 142
Philosophy and ethics 142
Oaths 143
What have we learnt over the past few decades? 143
Admissions process 143
Identification and remediation of unprofessional student behaviour 144
Teaching professionalism 145
Faculty and house staff development 145
The 'disruptive physician\u2019 in the hospital 145
Exemplary behaviour 146
Internet presence 147
How the US healthcare system and threats are changing professionalism 147
Professionalism in the new century 148
Summary 149
References 150
13 Ethical foundations of professionalism 152
Editors\u2019 introduction 152
Introduction 152
Religion as a source of professional ethics 154
Existential factors as a source of professional ethics 155
Social contract as a source of professional ethics 156
The biopsychosocial model as an ethical vision for mental health professionals 158
Professional ethics, organizational ethics and societal ethics: the Physician Charter 159
What is important about the ethics of professionalism? 160
Statements of professionalism as pious platitudes 160
Statements of professionalism as powerless ideals 161
Statements of professionalism as hypocrisy 161
Conclusions 161
References 163
14 Training in professionalism 164
Editors\u2019 introduction 164
Introduction 164
The need for formal training in professionalism 165
The evidence for effectiveness of training in professionalism 166
The role of assessment in driving learning to become a professional 167
The theoretical underpinning of interventions designed to facilitate professionalism in medicine: the theory of planned behaviour 168
Future directions 170
References 171
15 Expertise and medical professionalism 175
Editors\u2019 introduction 175
Introduction 175
Definition of medical professionalism 176
Challenges to medical professionalism 176
The profession and public trust 177
Competencies in medical education 179
Competencies in certification 181
Competencies in licensure and credentialing 182
Conclusions 184
References 185
16 Leadership and professionalism 187
Editors\u2019 introduction 187
Introduction 187
Contemporary ideas about leadership in mental healthcare 188
Leadership in clinical teams 190
Leadership in public mental health 191
Collaboration of mental health professionals with other sectors 191
Supporting the needs of people living with mental illness and their carers 192
Professional bodies as leaders in mental health policy 193
Case study: Royal Australian and New Zealand College of Psychiatrists 195
Workforce 196
Service integration 196
Increased accountability 196
Increased research opportunities 196
Outcome 196
Conclusions 197
References 198
17 Professionalism and psychiatry: The way forward 200
Introduction 200
Changing with the world 201
Medicine and the law: strengthening the partnership 201
Ethics at the heart of professionalism 201
Professionalism and expertise 201
Putting patients before self 201
New professionalism: relationships, teamworking and leadership 201
Teaching professionalism 202
Facing challenges head on 203
Conclusions 204
References 205
Index 206