On Being a Professional: 3 Axions. Right Reasons, Attitude, Aptitude.

I've stated for a time my rubric of Professional Practice as a rhetorical question:

When it is ever acceptable for a Professional to repeat, or allow, a Known Fault, Failure or Error? [A: Never]

Some larger questions arise but won't be dealt with here, but they imply a meta-level, the "Profession":

• Define 'Known' (which needs a means of transmission), and
• What are, or should be, the Consequences of unprofessional conduct or performance?

Healthcare, Medicine and the Learned Professions (eg. Law) have a special (higher) onus of responsibility on them. In the scale of Professional Duty, they are the most stringent and demanding:

• Fiduciary Duty or Trust:
•  "involving trust, esp. with regard to the relationship between a trustee and a beneficiary" [Oxford American Writer's Thesaurus]
• Fair Go, Fair Treatment.
• No Rules, Buyer Beware.

I argue that the Fiduciary Duty implicit in the Practitioner/Patient contract and relationship is demonstrated in the Hippocratic Oath, "First, Do No Harm,..."

This is a very high standard.

I take it to mean that Practitioner always places the Patients' welfare and health above their own concerns and needs, and those of their employer, supervisors and Professional Bodies.

Internal to this, I assert that the more radical or extreme the effects or possible adverse outcomes of the treatment/procedure are on the patient, they higher the duty of care. A variation of "Your Life in Their Hands".

• A surgeon or Intensive Care Physician can trivially cause immediate death or terrible permanent injuries. They have the highest level of Fiduciary Duty towards their Patients.
• Whilst the maker of a prosthetic device needs to avoid transmission of diseases, the use of toxic elements and have the device work safely. There is still a Fiduciary Duty towards the Patient, but it is much closer to the "Fair Go, Fair Treatment" level.

I'm positing three axions of Professional Practitioners, especially those with a Fiduciary Duty to their clients:

• Clean Motivation of Entry into and Practice in the Discipline: not Money, not Status, not Power/Prestige/Influence.
• If a Clinician is practicing because of the money, not primarily for providing good Patient Outcomes, they will routinely fail in their Fiduciary Duty.
• This is counter to the best interests of the Patient.
• A focus on pecuniary rewards will not sustain a Professional for their full working life. Once immediate goals are satisfied, what then? More of the same, or Just Cruising, not Caring?
• Caring for others outcomes is the first requirement for Quality and Continuous Improvement.
• Those who espouse, or act out, "Care Factor Zero", will not and cannot provide good Quality practice. If they have a Fiduciary Duty to others, they should be relived of duty without delay.
• Continuous Active Learning and Improvement.
• This isn't the 20-hours/year of mandated CPD (Continuing Professional Development).
• It's an inherent self-monitoring, self-examination of process, procedures and outcomes leading to Improvement in Quality of Care and Process (efficiency and effectiveness) and Adaptation and Improvement of Practice.
• A trusting and safe environment, "The fundamental Clinical Requirement", for the patient to "open up" into a full, frank and unstinting clinical communication.
• As human beings, we have 90 seconds to make a first impression. Recovering from a poor or antagonistic first impression is possible, but lengthy and time-consuming.
• Within that time, any clinical professional has to establish a basis of communication with the patient where they can be fully open, honest and complete in the clinical dialogue.
• "Why didn't you tell me before/when I asked" is the calling card of failure in this fundamental clinical requirement.
• Patients are both fully informed experts and ignorant. They know absolutely the experience of their own bodies, but can not be Clinical experts, even if they are trained in the field. This contradiction requires the clinician to both respect, not discount or ignore, what the patient is telling them and to fully draw out the patient experience. The patient will not be aware of apparently trivial or obvious details that are critical for swift, correct diagnosis by the clinician.

Lastly, there's the matter of Talent.

Some people are gifted in a field and given the same degree of training and practice, outperform us "mere mortals" by many times. Some might say "orders of magnitude".

The proof is Elite Athletes and Professional Sports. Talent counts, not just perseverance, determination and desire. Professional teams pay massive amounts for their stars, not 'the pack'. In professional tennis and golf, it shows up in earnings, both tournaments and sponsorship. The notional performance differences between #1 and #100 are small (<1% or 0.01%), but earnings are different by powers of ten. Talent counts as much in the clinical setting as on the sports field - and the results are similarly different.

Professions don't do themselves favours by allowing those of limited Talent to practice.

It diminishes the field and fails the patients.

Ironically, through the Dunning-Kruger effect (tone-deaf performers self-assess as virtuosos), this can institutionalise perverse selection and assessment regimes:

   when the professors are tone-deaf, they reward those like themselves and remove all others.

Exemplified by the claim: "I'm the Best XXX in the South-West/North/Area/City/State/..."

It's an error of logic of the kind: "compared to what? by whom?"