Much of the existing sociological work on professions and professionalism takes a structural approach (Macdonald 1995); the focus is on how groups of people professionalize, or how professionalism can be defined, which occupations count as ‘true’ professions (Johnson 1981). For this reason ‘professionalism’ is often dismissed as rhetoric. In order to achieve status and monopolistic position in the market for services of some kind, aspiring professionals are seen to stress the distinctness of their knowledge, the undoubted authenticity of their altruism and the responsibility of their members.
When professionalism is considered purely as a trope perhaps this is a legitimate line to take. However, it can overlook the fact that professionalism can also be regarded as a set of boundary setting practices. These practices no doubt contribute to status since they distance the professional from the client, but they may also benefit the client. For example, the practitioner may adopt a person in which his or her emotions or prejudices are back grounded and subordinated to the client’s task in hand (Cant and Sharma 1998).
Professionalism Professionalism in medicine is nothing more than the institutionalization of a male upper class monopoly. I must never confuse professionalism with expertise. Expertise is something to work for and to share; professionalism is – by definition – elitist and exclusive, sexist, racist and classist. In the American past, women who sought formal medical training were too ready to accept the professionalism that went with it.
They made their gains in status – but only on the backs of their less privileged sisters – midwives, nurses and lay healers. The main goal today should never be to open up the exclusive medical profession to women, but to open up medicine to all women. Professionalism is the ability to meet the relationship-centered expectations required to practice medicine competently. What does competence look alike?
The American Board of Medical Specialties (ABMS), the umbrella organization for certifying boards agree that competent physicians have abilities in the following areas: medical knowledge, patient care, professionalism, practice-based learning and improvement, interpersonal and communication skill, and system based practice. Professionalism integrates all these competencies. It can be observed, for instance, with practice-based learning and improvement when students or residents reflect on their performance and task themselves.
Professionalism interfaces with system-based practice when students or residents help patients obtain the care and resources they need to maintain health. Professionalism overlaps with interpersonal and communication skills and with patient care when students or residents are respectful in their interactions with others. The Healing System The integrative practitioner acknowledges the intrinsic restorative capacity of the human organism. Activation of this process is critical to an integrative practitioner’s decisions regarding which therapeutic choices are most beneficial for the patient.
Weil has described the concept of a “healing system” operating in the human organism, not intrinsically different in nature from the “endocrine system” the “nervous system, the “immune system,” or any other conventionally defined functional system in the human body. Like these other systems, the healing system is not specifically located in any single organ, but functions via a subtle and complex web of intracellular signaling systems affecting all levels of the organism, from the cellular level to the tissue-organ level to the levels of mind and spirit.
Weil gives an example of the process at the cellular level: when the DNA of a skin cell is damaged by ultraviolet radiation – potentially triggering mutation and unregulated replication, eventually leading to development of a skin malignancy – DNA lipase and a set of related enzymes within the damaged cell’s nucleus are automatically activated, resulting in the identification and removal of the damaged sequence, with restoration of normal replication.
If this level of “automatic healing” fails, then generally, once the cell has mutated and begun to replicate abnormally, immune cells will identify it as foreign and contain and destroy the affected group of cells – without any conscious action on the part of the person affected. At the level of tissues or organs, the spontaneous healing of wounds is an obvious example of the healing system at work.
The occurrence of an injury initiates a complex system of intracellular signaling, leading to local inflammation as a defense against infection, increased tissue perfusion to promote healing, and, ultimately, activation of fibroblasts and other cells to repair the damaged skin and subcutaneous tissues. Here again, although this process can potentially be influenced by certain inputs, including medications, botanicals, mind-body therapies, and others, the basic mechanisms of healing are intrinsic and require no intervention to be moved into action.
Summary Medicine is a cooperative art and a deeply satisfying profession. Students become professional by paying attention to the relationship of medicine-relationships with patients, colleagues, and mentors. Competence in professionalism is a habit, and its acquisition requires more than knowledge and skill. The inclusion of traditional medical system and other proven modalities in a healing-oriented framework brings us back to a more balanced stance that serves the physician, the patient, and ultimately, the health care system..