Intended for healthcare professionals

Opinion

Professionalism in 2024: today's doctors shouldn't be held to outdated ideas

BMJ 2024; 384 doi: https://doi.org/10.1136/bmj.q424 (Published 27 February 2024) Cite this as: BMJ 2024;384:q424
  1. Nicholas Phillips, final year medical student1,
  2. Marina Politis, final year medical student2
  1. 1University of Cardiff, Wales, UK
  2. 2University of Glasgow, Scotland, UK

Nicholas Phillips and Marina Politis question whether the concept of professionalism is always representative of today's medical workforce

Professionalism is a term that most healthcare professionals are familiar with, but defining it can be challenging and often varies by context and person. In recent years, there’s been growing awareness of how the concept of “professionalism” can be exploited to maintain the status quo, perpetuating a regressive norm of who a doctor should be, rather than benchmarking the standards they should follow while practising medicine. These biases can lead to the policing of people's individuality, harming the workforce, and entrenching inequalities and attainment gaps.

When medical students or doctors are told to subscribe to certain norms under the pretext of professionalism, or are accused of being unprofessional for deviating from someone else's cookie cutter ideal, it can feel like we're being held to ransom by outdated ideas of who a doctor is.

A mask of prejudice

The expectation that medics should fit a narrow professional mould can pressure them to change how they present characteristics associated with their sexuality, ethnicity, or gender—or else risk being labelled unprofessional.

Medical student, Nikki Nabavi, for example, reported receiving feedback from a senior colleague that she was “too girly.”1 The use of professionalism to perpetrate sexism and misogyny in healthcare environments even extends into examination settings. One medical student’s account of inappropriately receiving a “professionalism yellow card” during her OSCE for her outfit choice drew outrage on Twitter (now X) and prompted other female medics to share similar experiences.2 Other doctors have had expressions of their identity, such as tattoos or piercing, labelled as unprofessional.3

Beyond the UK, we have seen how clothing choices can be weaponised against doctors in cases such as #MedBikini, where researchers judged public social media posts of women wearing bikinis during time off as “potentially unprofessional.”4 When a group of male surgeons can decide what professionalism means for women, police them outside of their place of work, and this is published—the Journal of Vascular Surgery later issued a retraction—something has gone drastically wrong in the system.

Professionalism can also be used to attempt to disguise what is overt racism, such as Black women’s hair being more likely to be perceived as unprofessional.5 Experiences we’ve heard of such as a medical student being sent home by a white senior doctor for wearing their natural hair in an “Afro Puff” because this apparently looked “unprofessional” are all too common. The doctor subsequently suggested they should straighten their hair. This cannot be acceptable in UK medicine today.

Systemic misuse of professionalism

On a systemic level, professionalism can be misused as a tool that props up racist or discriminatory beliefs. Data show that Black and ethnic minority doctors are more likely to be referred to the General Medical Council and investigated.6 Given the racism that is endemic in the NHS,7 the disproportionate number of complaints and referrals experienced by ethnic minority doctors could be a sign of how their professionalism isn't given the same credit as their white colleagues. The day to day de-professionalisation of certain identities can result in these doctors being more likely to have their skills and character questioned, complained about, and investigated. High profile cases such as Manjula Arora and Hadiza Bawa-Garba forced the medical profession to reckon with the racism that can shape the regulation of doctors.8 As many commentators pointed out, if these cases involved white male doctors, would they have been managed in the same way?

In medical schools too, professionalism can be a thinly veiled disguise to mask discrimination or efforts to silence students. A BMA report listed shocking examples of healthcare students and professionals who had been told by senior colleagues that their queer identity and gender expression was unprofessional.9 We have also heard of students who, on attempting to raise concerns about senior colleagues, have had their worries dismissed as their inability to work well in a team or with varying personalities. We must all learn to work with people with different character traits, but we should not be taught that tolerating bullying or prejudice is a commendable sign of professionalism.

The common thread in many of these examples is that individuals and institutions with power can misappropriate the concept of professionalism, leading us to pose a wider question: who defines professionalism? The lack of diversity among people in senior medical positions means that the gatekeepers of professionalism may model the ideal on their own attributes and lack any incentive to change a status quo which has served them.

A future for professionalism

Professionalism is not an inherently negative concept. Professionalism is vital in a number of scenarios, such as instilling the importance of respecting colleagues and preserving patient confidentiality. Maintaining public trust in our profession and providing staff with healthy working environments is essential. However, can we say with conviction that this is what professionalism currently represents? Accounts of professionalism's inappropriate weaponisation to dilute individuality and diversity and conceal discriminatory beliefs suggest otherwise.

When professionalism becomes a vehicle for prejudice it should be challenged and we must move towards a new conceptualisation of what a professional doctor is and how they behave. As medical students, we must band together and hold our institutions to account, calling for reviewed definitions of professionalism that are representative and inclusive of today's society.

Ultimately, it is only fair to expect our regulatory bodies and institutions to embody the professionalism expected of us.

Footnotes

  • Competing interests: None declared.

  • Provenance and peer review: Not commissioned; not peer reviewed.

  • NP and MP are joint first authors of this article.

References