Introducing JAMA Professionalism.

This issue of JAMA marks the introduction of a new department: JAMA Professionalism. The goal of the articles in this section is to help physicians fulfill required competencies on this topic. According to the American Board of Medical Specialties definition, professionalism is “...a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to diverse patient populations.”1 Taking responsibility for executing professional responsibility seems intuitive enough. But what does it mean to adhere to ethical principles? How are the ethical principles defined? Recently, the American Medical Association issued an update to its Code of Medical Ethics stating that in order to conduct themselves ethically, physicians should “uphold the standards of professionalism.”2 These definitions create an apparent dilemma—being ethical means exhibiting professionalism and professionalism is defined, in part, by being ethical. “Perhaps the difficulty with teaching medical professionalism is that there seems to be no agreement on what the term actually means” noted DeAngelis in a 2015 JAMA theme issue on professionalism.3 In the same issue, Naylor and colleagues indicated that in both the United States and Canada, expectations for postgraduate medical education include 3 major tenets: knowledge, skills, and professionalism.4 In this context, professionalism is the application of knowledge and skills to deliver medical care and is difficult to define because professionalism represents almost everything a physician does while practicing medicine. The varied ideas of what should be considered medical professionalism emerged in JAMA’s professionalism theme issue. The nonmedical public view of medical professionalism is that physicians display good behavior, high values, and positive attitudes.3 Another view from the public perspective is that professionalism is manifested by the public entrusting physicians with autonomy and the ability to self-regulate in exchange for physicians being competent, altruistic, and moral while addressing the health care needs of society.5 Other definitions included physicians being resilient, adaptable, and good communicators and have the ability to work well in teams.6 Professionalism can also be expressed by a physician’s commitment to continuously self-assess and improve the quality of the care provided7 or that physicians follow standards the profession defines for itself without the need for government-imposed regulation of practice standards.8 The articles in the JAMA Professionalism section will reflect the multifaceted nature of this fundamental aspect of beingaphysicianandpracticingmedicine.Eacharticlewillpresent individual casesof actualmedical scenarios inwhichprofessionalism is required to address important issues and solve difficult problems. For instance, how should a resident physician solve thedilemma regarding theneed to adhere towork hour restrictions vs spending more time with a patient? How should physicians respond when they have observed or participated in amedical error that is undisclosed to the patient? How do clinicians address disrespectful communication betweenphysicians andnurses?Howshould cliniciansdealwith conflictswith administrators about resource allocation in the health care system? These scenarios will touch on the many aspects of how professionalism factors into medical decision making. The scenarios will be explored using the following logic. Consider the situation in which a resident must decide between complying with regulations when those regulations are in conflict with the delivery of patient care. How are the priorities established? How does the trainee approach supervisors who are charged with resolving these conflicts and who, exactly, should the trainee talk to? When physicians witness conflicts between personnel in the health care environment, what is their responsibility to intervene? From where does the authority flow should they decide to get involved? If the action is reportable, who is responsible for receiving the information? When physicians observe inadequate clinical care because of poor administrative decisions, what should they do about it? The examination of these scenarios and explanation of potential solutions will help physicians better understand how professionalism helps guide their actions and learn from the experience of the physicians who were involved in the cases. The first article in the JAMA Professionalism series discusses the dilemma a physician encountered when he learned after he performed skin biopsy procedures that the instruments he used were not sterile.9 As a clinician, he first needed to determine what the risks of infection were and then disclose the error and those risks to the patients. He also had to consider risk management and any potential liability issues. He needed to consider how to interact with the quality improvement program to ensure the error was not repeated. Reflecting the multiplicity of definitions for professionalism, physicians assume a variety of roles and responsibilities when addressing professionalism issues. In this case, the physician needed to be compassionate and responsible by fully informing the patients of the error without needing external regulations telling him he needed to do so. He needed to be involved in the performance improvement group of his clinic to understand how the error occurred and Related articles pages 698 and 764 Opinion