Core Competencies

Professionalism and Medical Ethics. 2017 Hospital Medicine Revised Core Competencies

© 2017 Society of Hospital Medicine

Professionalism refers to attitudes, behaviors, and skills for physicians to serve the interests of the patient above his or her self-interest. This denotes a commitment to the highest standards of excellence in the practice of medicine and to the generation and dissemination of knowledge to sustain the interests and welfare of patients. Within the practice of hospital medicine, professionalism also includes a commitment to be responsive to the health needs of society and a commitment to ethical principles.

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KNOWLEDGE

Hospitalists should be able to:

  • Define and differentiate ethical principles, which may include beneficence and nonmaleficence, justice, patient autonomy, truth-telling, informed consent, and confidentiality.

  • Describe the concept of double effect.

  • Define and distinguish competency and decision-making capacity.

  • Explain the utility of power of attorney and advance directives in medical care.

  • Describe the key elements of informed consent.

  • Explain determination of decision-making capacity and steps required for surrogate decision-making.

  • Describe local laws and regulations relevant to the practice of hospital medicine.

  • Explain medical futility.

  • Recognize when consultation from others who have expertise in psychiatry and ethics will promote optimal care for patients and help resolve ethical dilemmas.

  • Recognize the obligation to report fraud, professional misconduct, impairment, incompetence, or abandonment of patients.

  • Recognize potential conflicts of interest in accepting gifts and/or travel from commercial sources.

  • Recognize potential individual and institutional conflicts of interest with incentive-based contractual agreements with pharmaceutical companies and other funding agents.

SKILLS

Hospitalists should be able to:

  • Observe doctor-patient confidentiality and identify family members or surrogates to whom information can be released.

  • Communicate with patients and family members on a regular basis and develop a therapeutic relationship in both routine and challenging situations.

  • Recommend treatment options that prioritize patient preference, optimize patient care, include consideration of resource use, and are formulated without regard to financial incentives or other conflicts of interest.

  • Evaluate patients for medical decision-making capacity.

  • Obtain informed consent when indicated and ensure patient understanding.

  • Review power of attorney and advance directives with patients and family members.

  • Adhere to ethical principles and behaviors, including honesty, integrity, and professional responsibility.

  • Respect patient autonomy.

ATTITUDES

Hospitalists should be able to:

  • Commit to lifelong self-learning, maintenance of skills, and clinical excellence.

  • Promote access to medical care for the community, especially in underserved areas.

  • Demonstrate empathy for hospitalized patients.

  • Provide compassionate and relevant care for patients, including those whose beliefs diverge from those of the treating physician or from accepted medical advice.

  • Remain sensitive to differences in patients’ sex, age, race, culture, religion, and sexual orientation.

  • Appreciate that informed adults with decision-making capacity may refuse recommended medical treatment.

  • Appreciate that physicians are not required to provide care that is medically futile.

  • Endorse that physicians have an obligation not to discriminate against any patient or group of patients.

  • Recognize and observe appropriate boundaries of the physician-patient relationship.

  • Follow a systematic approach to risks, benefits, and conflicts of interest in human subject research.

  • Serve as a role model for professional and ethical conduct to house staff, medical students, and other members of the multidisciplinary team.

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