6. Professionalism in the Practice of Osteopathic Medicine

Overview

Osteopathic physicians must understand and adhere to the ethical, behavioral, and social science principles that underpin medical professionalism, demonstrating accountability to patients, society, and the profession. Osteopathic physicians must consistently display high moral and ethical standards in the conduct of medical education, training, research, and practice. This conduct includes properly establishing, maintaining, and concluding the physician-patient relationship in a manner that is altruistic, compassionate, and conscientious. Osteopathic physicians must exemplify integrity, humanistic behavior, and a responsiveness to the needs of patients that supersedes self-interest. They must show respect for the patient as a person and demonstrate cultural sensitivity and responsiveness to a diverse patient population. While professionalism also includes a commitment to excellence and continuous professional development, these attributes are classified in the practice-based learning and improvement domain (Domain 4).

Required Elements

6.1 Knowledge of Ethics and Professionalism

DEFINITION The osteopathic physician must demonstrate sufficient knowledge of the behavioral and social sciences that provide the foundation for the professionalism competency, including medical ethics, social accountability, and responsibility. MEASURED OUTCOMES The osteopathic physician must:

• articulate moral, legal, and ethical guidelines for professional behavior.
• explain and apply the ethical principles of autonomy, beneficence, nonmaleficence, fidelity, justice, and utility.
• identify the patient’s social and economic situation, capacity for self-care, and ability to participate in shared decision-making.
• identify and describe the impact of social inequalities in health care, including public health crises, and the social factors that are determinants of health outcomes.
• comprehend and apply the concepts of social accountability and responsibility.

6.2 Humanistic Behavior

DEFINITION The osteopathic physician must demonstrate respect, altruism, compassion, integrity, honesty, and trustworthiness. MEASURED OUTCOMES The osteopathic physician must:

• exhibit respect and compassion for the patient’s autonomy, dignity, and privacy.
• exhibit openness, honesty, and trustworthiness with patients and their families in the completion of all reports and during the provision of evidence in any formal inquiries, including those related to litigation.

6.3 Primacy of Patient Need

DEFINITION The osteopathic physician must demonstrate responsiveness to the needs of patients and society that supersedes self-interest. MEASURED OUTCOMES The osteopathic physician must:

• use reason and appropriate judgment, and incorporate the patient’s perspective when taking into consideration risks to the patient’s health, income, and job security.
• respect patient autonomy and the right of the patient to be fully involved in decisions about care.
• respect the right of the patient to personal privacy and dignity during evaluation and management.

6.4 Accountability and Duty in the Physician-Patient Relationship

DEFINITION The osteopathic physician must properly establish, maintain, and conclude the physician-patient relationship in accordance with proper ethical and legal standards. The osteopathic physician must demonstrate accountability to patients, society, and the profession. MEASURED OUTCOMES The osteopathic physician must:

• take appropriate action to protect patients from risk if the physician has good reason to believe that they or a colleague may not be fit to practice or when unprofessional behavior compromises patient care or represents a threat to patients or others (e.g., impairment, substance abuse, incompetence, unethical conduct, inappropriate relationships).
• properly establish the physician-patient relationship by examining, diagnosing, and treating in a consensual manner, and conscientiously maintaining the relationship consistent with proper ethical and legal standards.

6.5 Cultural Competency

DEFINITION The osteopathic physician must demonstrate sensitivity, respect, and responsiveness to a diverse and heterogeneous patient population, including but not limited to diversity in culture, religion, age, gender, sexual orientation, socioeconomic circumstances, mental and physical disabilities, and military personnel and their families. MEASURED OUTCOMES The osteopathic physician must:

• demonstrate cultural awareness, respect, and responsiveness when communicating with the patient, family, caregivers, and other members of the health care team.
• discuss cultural issues openly and be responsive to culturally based cues, interpreting the implications of symptoms as they are expressed by patients from diverse cultures and circumstances.

6.8 Ethical Principles in Practice and Research

DEFINITION The osteopathic physician must demonstrate knowledge of, and the ability to apply, ethical principles in the practice and research of osteopathic medicine, particularly in the areas of confidentiality of patient information, access to care, regulation of care, provision or withholding of care, and the conduct of research. MEASURED OUTCOMES The osteopathic physician must:

• provide appropriate care to address physical, emotional, and spiritual pain and minimize needless helplessness or suffering.
• use ethical principles pertaining to provision or withholding of clinical care, including diagnostic and treatment modalities that are considered futile.