Assignment Session 1
Haldeman et al. (2, p202) define a profession as “a social group that has exclusive access to knowledge and skills…and has exclusive powers and or rights”. While this definition is not complete, it forms the basis for what distinguishes a profession from other societal groups and thus the professional from the public, in that a professional possesses knowledge and skills above and beyond that of a member of the public (2). Professional identity and the framework for what defines professionalism stem from a social contract, an implicit agreement between so called professionals and the public they serve (1). This social contract, when honoured by both the professional and the public allows for the development of a professional identity and can foster public trust in a profession. It is the exclusive knowledge and skills possessed by a professional, that when used for the benefit of society, grants the powers and or rights to use them (2). It is important to note that while regulating bodies exist both within the profession and externally, it us ultimately the public that grants the powers and or rights to the profession (2).
The definition of a profession and the professional has so far been summed up by the knowledge, skills, powers and rights possessed by and granted exclusively to the profession and members there of. It is however, professionalism and the continued adherence to the social contract that truly establishes professional identity. The definition of professionalism is fluid and dynamic based largely upon the individual profession and its scope and it is an understanding and adherence to the profession and societies expectations that form and maintain a professional identity. Haldeman et al. (2) outline the following elements of professionalism in chiropractic: Teaching, Scholarship and Research, Service, Resolution in Differences of Opinion, Personal Evolution and Growth, Demeanor, Professional Conscience, Competition, Quality Improvement, Needs of Underserved Populations, Self Promotion, Evidence Informed Practice and Inter- and Intraprofessional Interaction. An entire book could be devoted to each element of professionalism in chiropractic listed above, however the take home point is that professionalism is the continued endeavour by the professional to conduct themselves in a manner both on and off the clock that appropriately addresses the scope of their profession, congruent with the expectations of both the profession and the public.
A chiropractic student, a young professional, begins to form a professional identity the day they begin their education, and it evolves with every new experience. With this comes professional privilege and, perhaps, the first taste of social obligation. One of the most important professional privileges granted to medical professionals is that of autonomy (1). Autonomy is the right to make and act upon certain decisions without direct interference or approval. In terms of professional identity, a licensed chiropractor may assess, diagnose and treat a patient based on his or her own knowledge and skills, while a chiropractic student in their clerkship years must consult a supervising clinician at each step. In other words, a practicing chiropractor has been granted the privilege of autonomy, the student has not. The power associated with privilege is balanced by the accompanying social obligation. In the case of autonomy, the public grants the privilege with the expectation that the practitioner will place the patient’s interests above that of their own, expecting the professional to use their exclusive knowledge in the benefit of the patient, a concept known as “credat emptor (let the taker believe in us), rather than “caveat emptor (let the buyer beware)” (1; 2, p203).
When defining professional identity and professionalism, particularly in the health care field, an understanding of ethics and morals is essential, as they are the basis for which every element of professionalism stems from. The concepts of ethics and morals in health care both deal with professional conduct and a universal standard (2). The framework by which judgments are made concerns the ethics, while the individual action or behaviour concerns a moral decision (2). In order to embody professionalism and maintain a just professional identity, a professional must use an ethical framework for decision making, and ultimately follow through when working within any and all elements of professionalism. The ethical framework, an accepted universal standard, guides the professional and defines professionalism within the profession, while the individual actions and behaviours, the moral decisions, define each professional, ultimately creating and maintaining their professional identity.
- Cruess SR, Cruess RL. Professionalism and Medicine’s Social Contract with Society. AMA Journal of Ethics [Internet]. 2004 Apr [cited 2016 Sep 10]; 6(4). Available from: http://journalofethics.ama-assn.org/2004/04/msoc1-0404.html
- Haldeman S, Dagenals S, Budgell B, Grunnet-Nilsson N, Hooper PD, Meeker W, et al., editors. Principles and Practice of Chiropractic. 3rd edition. McGraw-Hill. 2005