In a previous posting I talked about professionalism in the context of interprofessional respect and relationships. Like many terms once you start to move away from your own concepts you find that there has been considerable discussion and debate about definitions in the past. Andrew Cole writing in the BMJ in 2005 introduced the report from the Royal College of Physicians: Doctors in Society: Medical Professionalism in a Changing World. The report redefined medical professionalism as “a set of values, behaviours and relationships that under pins the trust the public has in doctors.” I can see this is perhaps a necessity after the public has been so disturbed by scandals involving doctors. Following the encouragement of the Hong Kong Medical Council, medical professionalism is now a designated module for all final year medical students at our University. I asked my students last week what they had learnt about medical professionalism in their module. Incidentally my offer of help in this teaching assignment was declined; so no COI! One topic that caught their attention was a special talk from the ICAC (the Independent Commission Against Corruption). This is a very interesting institution in Hong Kong that was originally set up to investigate police corruption during British Colonial Rule. The ICAC is as strong as ever in the post-colonial period. A notable recent “catch” in the medical world was the case of Lam Shiu-Kum, former Dean of the Faculty of Medicine of Hong Kong University. He was given 25 months in prison to reflect upon his lack of professionalism in pocketing donations intended for the University and various other acts of fraud and theft. Embarrassing indeed and completely unacceptable but I was surprised that none of the students had heard anything about Harold Shipman within their integrated module. Certainly compared to Harold Shipman, Lam Shiu-Kum’s crimes pale into relative insignificance. But I have to include the qualification “relative.” If you look at the diagrammatic representation of Professionalism in the Brody School of Medicine website we do see a far more complex schematic than just the four great cornerstones of medical ethics; autonomy, beneficence, justice and Non-malfeasance.

The General Medical Council (GMC) has taken on board the need to focus on acceptable and non-acceptable standards of behaviour relating to the good practice of medicine. Of particular interest is that the GMC does stress the need for appropriate behaviour with regard to respect for colleagues (para 46 and 47). When a senior member of the profession very publically and dishonestly defames another senior member of the medical profession, this is completely unacceptable behaviour. Defamation is a crime but the pursuit of justice through the court and processes of law is costly protracted and weighted to the advantage of the wealthy. If a senior doctor knowingly tells mistruths against another doctor bringing their reputation into disrepute, this can be resolved by law but alternatively this is an issue that strikes at the very heart of Bad medical practice; unprofessional behaviour. The GMC must investigate such cases and bring very severe sanctions against those who are dishonest in their dealings with colleagues. I hesitate when I hear people talk about “zero-tolerance,” when sometimes aspirations are so high and the spectrum of aberrant behaviour so wide. But senior doctors who engage in defamation should not be made to feel welcome in the profession of medicine. This is another very important lesson for medical students and one that the GMC can reinforce by appropriate sanctions in specific cases. Looking at cases related to relationships with colleagues that have been brought in front of the Fitness to Practise Panel, most appear to concern inappropriate sexual behaviour. But the GMC should take a pragmatic view at the strategies of prevention; the removal of a senior person from the Medical Register for publically defaming another colleague would deliver a very strong message to younger member of the profession that appropriate behaviour in medicine is as important as appropriate practice.

Andrew Burd is professor of plastic, reconstructive and aesthetic surgery at the Chinese University of Hong Kong. His major clinical interests involve paediatric burns care and the role of plastic surgery in the palliation of advanced malignancy. Academic interests include pragmatic ethics related to the practice of medicine including research and publication.