1. Celebrating the Opening of the China-U.S. Joint Center on Medical Professionalism David J. Rothman, Ph.D. President, Institute on Medicine as a Profession Professor of Social Medicine, Columbia College of Physicians and Surgeons Peking University Health Science Center – October 20, 2008

2. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 2

3. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 3 Attributes of Professionalism Altruism and commitment to patients’ interests Maintenance of technical competence Self-regulation Advocacy and civic engagement on behalf of the patient and the society

4. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 4 Self Regulation At the Essence of Concept of Professionalism  The task of doctoring is complex. Medical knowledge is not widely shared and is of great value.  Trust by the community and the government in physicians. A confidence that the profession will exercise oversight properly.

5. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 5 Self Regulation (cont.) In the US, a mixed record  Do not over see colleague’s performance adequately  Do not always rein in bad practices - anti-aging clinics

6. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 6 Self Regulation (cont.) What May be done to Enhance Professional Self-Regulation?  Medical Schools: Greater emphasis on responsible team work as well as individual performance.  Medical Societies: Greater involvement in oversight of medical practices.

7. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 7 Self Regulation (cont.) What May be done to Enhance Professional Self-Regulation?  Hospitals: Greater oversight through such mechanisms as granting hospital privileges and group conferences (Morbidity and Mortality rounds)  Government and Ministries of Health: Protect and value the concerned physician

8. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 8 Advocacy and Civic Engagement Advocacy for the individual patient Advocacy for all patients

9. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 9 Advocacy and Civic Engagement (cont.) A long and well accepted tradition of the individual physician advocating on behalf of the individual patient What are the physicians obligations to carry out public advocacy?

10. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 10 Advocacy and Civic Engagement (cont.) Why turn to physicians? In the US, a very prestigious group Have a very special perspective: the patient encounter Do have special expertise which can be used in advocacy

11. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 11 The Record on Advocacy in the US The more Successful Physician Advocacy has been when: The issue is targeted and specific The vested interests are weak

12. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 12 The Record on Advocacy in the US (cont.) Where advocacy does not confront strong vested interests, greater success:  Seat belt laws  Accident prevention— traffic lights  School health programs  Housing improvement—radiator protection

13. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 13 The Record on Advocacy in the US (cont.) Where advocacy confronts a specific interest group, mixed success:  Eliminating smoking (tobacco industry)  Eliminating alcohol use in minors (alcohol industry)  Combating obesity (food industry)

14. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 14 The Record on Advocacy in the US (cont.) Where advocacy confronts diverse and powerful interest groups, minimum success:  National health insurance  Environmental Issues

15. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 15 The Record on Advocacy in the US (cont.) Models for the conduct of physician advocacy Within practice settings In the community at large Gruen, Russell L.; Pearson, Steven D.; Brennan, Troyen A. (2004). “Physician- Citizens – Public Roles and Professional Obligations.” JAMA. 291 (1), 94-98.

16. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 16 The Record on Advocacy in the US (cont.) Within Practice Settings: Discuss issues: With patient With colleagues With hospital officials Providing care regardless of ability to pay

17. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 17 The Record on Advocacy in the US (cont.) In the community at large: Speaking with family, friends, and at public forums Joining with a medical society to promote a shared goal

18. David J. Rothman Medical Professionalism and the Engaged Physician: Setting the Agenda 18 The China-U.S. Joint Center on Medical Professionalism Setting the agenda will be an exciting task Two essential components may be:  Self regulation  Advocacy and civic engagement