Professional Integrity and the Role of Medical Students in Professional Self-Regulation

The concept of medicine as a profession is founded on trust, both that physicians will practice and teach to high intellectual standards and that physicians will seek to promote and protect the interests of patients over and above their own interests. These standards define the ethical concept of fiduciary professionalism expressed in part by the professional virtue of integrity. Integrity is the bedrock virtue, and it is defined by a commitment to practice medicine in accord with the standards of intellectual and moral excellence. It is heartening to know that the concept of medicine as a profession has a history dating back to the eighteenth century, originating from the work of John Gregory (1724–1773) who heavily influenced Thomas Percival (1740–1804) [1]. Percival in turn was a major influence on the first (1847) Code of Ethics of the American Medical Association [1]. It is also heartening to know that the concept of medicine as a profession is not limited to Western culture but is a transnational and transcultural concept that applies to all levels of medical practice, research, and education today [2]. Maintaining the public’s trust in the medical profession requires an ongoing active commitment to the professional virtue of integrity by individual practitioners supported by organizational culture of professionalism. Healthy medical organizations, as public trusts and not merchant guilds, similarly limit self-interest including financial self-interest because they exist primarily for the benefit of patients and their communities [3]. Individual practitioners and organizational and educational leaders are responsible for the hard work of preventing an erosion of professional standards and for regulating the culture of medicine. Healthy organizations demonstrate their commitment to professionalism by learning from reports of wrongdoing how to prevent them from recurring. One goal is to prevent the potential for wrongdoing proactively and nonjudgmentally in order to reduce the need for disclosure and intervention. Should preventive measures fail, the second measure requires authorization for formal reports or “whistleblowing.” Whistleblowing constitutes one among many important methods of self-regulation within the profession, an approach that exists for maintaining and improving professional standards. In general, a whistleblower is a person who reports observed wrongdoing [4, 5]. The assumption we make is that the person who makes such a report does so honestly, out of respect for the standards of the field and with compassion for the individual or individuals who may be hurt, e.g., a patient or a student, and with a concomitant compassion for and sensitivity to the alleged wrongdoer. The person reporting wrongdoing may have to confront a culture that is permissive of the behavior of concern or that is resistant to adopting the changes necessary to address the concern. While “whistle-blowing” may seem to have negative connotations, we need to fully embrace the concept of self-regulation if we are truly serious about creating mandated, publicly accountable clinical learning environments grounded on patient safety and healthcare quality. * John H. Coverdale jhc@bcm.edu