Describing the essential ingredients of professionalism is even more difficult, and although the term 'professional integrity' is widely used, it is perhaps less well understood
A profession has been defined as a vocation or 'calling', especially one involving a degree of skill, learning or science. Another helpful description is that of 'a trade or occupation pursued for higher motives, to a proper standard'.
The distinction is usually drawn between a professional (ie. someone who earns a living from their trade or occupation), and an amateur (ie. someone who might do the same or a similar thing, but without remuneration). But the difference is not simply that one is paid and the other is not, because a 'professional' performance is one which is good, polished and of a high quality, whereas an 'amateurish' performance is the opposite - no matter how much or how little payment might have been received.
A logical conclusion from this is that if one intends to rely upon a certain trade or occupation as the main source of one's income and living, then one would need to be proficient at it, and recognised as being so.
Integrity is generally defined as wholeness, honesty and 'uprightness', being in sound and intact condition, undamaged, untainted. It also implies being solid, complete and undiminished in stature.
Integrity can be neither lost nor concealed, nor faked, nor quenched, nor artificially come by, nor outlived. Nor I believe - in the long run - denied
Eudora Welty (1909-2001)
From this it follows that your professional integrity is a measure of the degree to which your own professional reputation and credibility remain intact. It is more than just clinical or technical excellence alone, since a major element of a person's integrity derives from the way in which they are viewed by others.
Anything which has the potential to reduce a professional person's reputation in the eyes of another undermines their professional standing. Your professional integrity can be impugned not only because of a proven misdemeanour, inappropriate act or omission, but even by the faintest suggestion of such things. When professional integrity remains intact, doubts such as these do not arise. When this is not the case, such doubts can have the effect of compounding any existing damage.
Professionalism
There are several characteristics that are expected of a professional person, and more specifically, in a dentist. Some will apply equally to all professions, while others are more specific to healthcare, and to dentistry in particular.
The function of undergraduate training is not only to prepare an individual academically, intellectually and technically for a career in dentistry. It is also an opportunity to equip them with the other skills and attitudes that will be needed when, upon graduation and registration, they join the ranks of their professional colleagues.
Expertise
A professional person is expected to have a special set of skills and expertise in their chosen field. This will have been acquired through learning, knowledge, training and practice of the relevant skills and in most cases this is demonstrated by qualifications or accreditation of some kind. The validity of this expertise is maintained by ongoing training throughout the course of a dental career.
Standards
A professional person is expected to have the ability and commitment to carry out his/her range of activities to a standard which is regarded by other authoritative members of that profession, as being acceptable. In the case of the professions, the expected standard will be significantly higher than an untrained or unqualified person might be capable of achieving.
Respectability
The same person will be expected to work and behave in a manner that is appropriate to a an individual purporting to have the skills of the relevant profession. In the case of dentistry these attributes will include cleanliness and personal hygiene, appropriate standards of dress and appearance, all of which should confirm a respectable standard rather than raising doubts and concerns.
Responsibility & reliability
A professional person is expected to demonstrate a high level of responsibility and reliability. They will always do their best to honour any commitments they make, and to keep their promises. They will understand that other people are relying upon them, and take these responsibilities seriously.
They will be dependable, and where necessary they will 'travel the extra mile' to ensure that things are done as intended.
What is professional behaviour?
A professional person:
- Will take pride in doing a job well and paying attention to detail.
- Will seek to develop and improve their skills.
- Will not be satisfied with a substandard result, and will seek to put things right.
- Will be prepared to acknowledge mistakes, will learn from them and will take appropriate steps to prevent a recurrence.
- Will show respect for those who consult them in a professional capacity.
Probity
(from the Latin; good, honest, upright)
A professional person will be honest and decent, fair, trustworthy, law-abiding, and of good character. Their actions will be ethical, and they will uphold the reputation of the profession and help to maintain public confidence in it.
Behaviour
A professional person will act in a way which is seen as being appropriate and proper:
- By members of the public, given their expectations of the profession.
- By professional colleagues.
Attitude is a state of mind that can significantly influence behaviour. Adopting a positive attitude to life and work can help you to ensure that your treatment of patients is both caring and non-judgemental.
Respect
A professional person will respect authority and the rule of law, and when managing or employing others will set a good example, and act fairly and reasonably at all times. A professional person will be polite and courteous and will respect the rights, dignity and autonomy of others at all times (Ethics module 7)
A professional is a person who can do his best at a time when he doesn't particularly feel like it
Alistair Cooke, Broadcaster (1908-2004)
Unprofessional behaviour
Having defined some of the characteristics of a professional person, it is easier to understand what kind of behaviour might be considered 'unprofessional'.
For example:
- Any criminal behaviour or a conviction.
- Behaviour which suggests a disregard for the well-being of patients (or members of the public) and/or their dignity and rights.
- Cancelling patient's appointments at short notice, or failing to attend a surgery/clinic to treat patients who have been given appointments, unless this is due to circumstances beyond the dentist's control.
- Rude, abusive or disrespectful behaviour.
- An irresponsible or 'couldn't care less' attitude.
- Showing an inappropriate disregard for the time and effort of those who are relying upon them; for example, by consistently bad timekeeping.
- Dishonest business/financial dealings.
- Any abuse of the dentist/patient relationship.
- Anything that undermines public confidence in the profession.
- Anything that undermines the reputation or standing of the profession.
- Selfishness; putting one's own financial or personal interests above all other considerations.
- Being content with unsatisfactory clinical standards.
- Gratuitous criticism of colleagues and others.
- Inappropriate relationship with patients, employees etc.
- Treating patients when not fit to do so.
- Agreeing to undertake a procedure for which the person lacks the necessary training, expertise or competence.
- Being resistant to improving standards or maintaining one's continuing professional development.
- Laziness, sloppiness or a lack of attention to detail.
Just being honest is not enough. The essential ingredient is integrity
Philip Crosby, Management Consultant (1926-2001)
Advertising and promotion
In some countries, almost any kind of practice promotion is permitted, whereas in others nothing more than a modest entry in a telephone directory is allowed. Guidelines on advertisements, newspaper/magazine articles and websites, are published by Dental Boards/Dental Councils in many countries.
There are wide differences between different countries around the world, in the extent to which dentists and dental practices can be promoted or their services advertised. It is essential to familiarise oneself with the professional standards that apply locally, in any country where you are practising.
Dentists should, in any event, avoid suggesting that they are superior in any way to other professional colleagues, or that a colleague may be inferior in some respect. They should not make claims - directly or indirectly - that cannot be substantiated, or which are excessive/exaggerated or presented in a way which is not in keeping with professional propriety.
Some owners of dental practices find these constraints extremely frustrating, outdated and unnecessarily restrictive. This frustration can lead them to push against established professional boundaries and this brings them into conflict with regulatory bodies (Dental Boards, Dental Councils) as well as with their professional colleagues.
Integrity without knowledge is weak and useless, and knowledge without integrity is dangerous and dreadful
Samuel Johnson (1709 - 1784)
Such frustrations are often felt by younger dentists in particular, who might feel that restrictions on practice promotion, advertising and canvassing for patients is simply designed to protect the interests of the established practices and senior members of the profession, while denying patients the information from which to make informed choices between different providers of healthcare. In countries where there is felt to be an oversupply of dentists, a sharp difference of opinion of these matters is often encountered between older, well established dentists, and young dentists who are starting out on their professional career.
Some dentists and practice owners see themselves as crusaders in their willingness to challenge the status quo in this and other respects. But there are also ways of expressing one's opinion within normal scientific and dento-political forums, through consultation, discussion and professional debate. Simply refusing to comply with accepted professional standards and guidelines simply because you disagree with them, is not generally a sensible strategy. Nor is it a professional response, whatever the provocation.
This is not to say that there will never be a justification for extreme measures, or the resolute pursuit of a point of principle. What distinguishes a professional person is the way in which they choose to make their point.
Integrity has no need of rules
Albert Camus (1913-1960)
Conflicts of interest
Your professional integrity could easily become tainted by being involved in any arrangement where financial or other kinds of inducement is offered or accepted with the aim of influencing your professional behaviour, or that of others. Such arrangements often involve financial and other inducements being paid in return for the referral of patients, or for expressing/promoting certain views.
The key to avoiding this situation - whether the conflict is real or simply perceived by others - is to avoid any situation where the opportunity to exercise your professional judgement could be compromised or influenced by the subject on which a decision is about to be made.
As professional people, we are sometimes privy to information that would not be available to others. Some of this information relates to our patients, some to our professional colleagues, and some will relate to other matters. As professional careers develop, many dentists become increasingly involved in work representing the interests of others, perhaps serving on committees or acting as consultants or advisers. The more involved you become in such work, the greater the possibility that conflicts of interest will arise.
Real integrity is doing the right thing, knowing that nobody's going to know whether you did it or not
Oprah Winfrey (1954-)
A conflict of interest exists either when your own knowledge of the people involved, or the surrounding facts, would make it difficult for you to give an entirely independent or disinterested opinion or an impartial judgement in a particular situation. Alternatively, you may have (or be seen to have) an interest in the outcome by virtue of a position or relationship held that is directly or indirectly related to the matter under consideration.
Even when you firmly believe that you could remain impartial and objective, and distance yourself sufficiently from any special knowledge you might have, it is the perception of such conflict that can be damaging not only to the issue under discussion and its outcome, but also to your own professional reputation.
Despite this, some dentists regularly allow themselves to accept positions of conflict. They seem unable or unwilling to recognise these conflicts, or to understand the damage which results. This raises questions about the person's integrity, especially if it is perceived that the person's determination to ignore the conflict (or potential conflict) is driven by selfish or unworthy motives.
Keeping promises
From the public perspective, part of the comfort and security derived from dealing with professional organisations or professional people, stems from a confidence that commitments and undertakings will be honoured. It is unacceptable for professional people to make promises that they don't intend to keep, or to agree to do something that they are highly unlikely to achieve. Over-promising and underdelivering on those promises is a sure way to generate dissatisfaction and to undermine any relationship whether it is of a business, professional or personal nature. Patients, the general public and third parties all place their trust in professional people, and their expectation is that this trust is well founded.
A striking feature of many complaints against professional people is a feeling on the part of the complainant that they have been 'let down' by someone in whom they had placed their trust and confidence. If the patient feels - rightly or wrongly - that they have been told something that wasn't true, or deliberately misled by a professional person, or overcharged, their sense of outrage tends to be heightened.
This returns us of the definition of a professional which started this article - a profession is pursued 'for higher ideals'. In short, the public expects from anyone who is providing professional services, everything that they would expect (or have a legal right to receive) from any other person, business or organisation whose goods and services are being purchased, plus a whole lot more in the case of dentists. Call it ethics or professionalism if you like, but what it means is that the professional person can be relied upon to act in an honourable fashion.
Rectification
This expectation and belief in the reliability of a professional person has yet another dimension.
Professional people are still human, not superhuman, and they will not be able to achieve perfection in all their endeavours, no matter how hard they try. But members of the public have greater faith and confidence that the professional person will put things right, than one might normally have on other occasions when dealing with other people.
A man should be upright, not be kept upright
Marcus Aurelius Antonius, Roman Emperor (121-180)
Professional people demonstrate their commitment to putting things right (either personally, or through their indemnity arrangements, or third parties) because first and foremost it is the responsible and proper thing to do. It is another example of the 'higher motives', especially if this rectification is done at the professional person's own expense.
Social responsibility
A professional person is expected to be socially responsible. Examples of this might include:
- Compassion for those suffering pain and hardship.
- A proper and responsible role in society (paying taxes in timely fashion might be seen as a part of this).
- A responsible attitude to the environment (especially in relation to the management of clinical and hazardous waste, the use of energy and raw materials).
- Good employment practices (in the case of practice owners and managers).
- An awareness of social issues where the dental profession is in a position to play an important or central role (for example in relation to physical abuse in all its forms, discrimination etc).
- Humanity in both professional and personal matters (for example, providing assistance in an emergency situation which one encounters outside the normal professional setting).
- Adherence to the law (for example, in relation to substance abuse, driving while unfit to do so etc).
- Whether they realise it or not, professional people are often in a position where they may be regarded as role models by others.
Summary
This explanation of the nature of professionalism is not intended to be exhaustive. The difference between professionalism and the lack of it is seen most clearly in the behaviour and reactions of different individuals when placed in similar situations.
Doing what is right - when the law requires it, as well as for ethical or moral reasons - should be a matter of personal pride for the professional person.
Persisting in doing what is right, on those occasions when it is much easier, quicker and cheaper or more convenient to do otherwise, is a greater test.
Some will no doubt maintain that the ethos of professionalism and the instinct which tells us what a professional person would do in a given situation can only develop with experience. Others will contend that professionalism is simply about choices, and making the right ones, for the right reasons, no matter what stage in your professional career these decisions arise. There may be some truth in both perspectives, but it can never be too soon to think these issues through.
Professional integrity is a precious attribute which needs to be cultivated and protected from the very start of a professional career.