June 1989 X/10
PROFESSIONALISM: THE ESSENCE IS EMPATHY
The concern for assuring ethical behavior on the part of health care professionals continues to mount. The U.S. Congress contemplates regulations which would limit the investments in clinics and laboratories by physicians receiving medicare or medicaid payments. (N.Y. TIMES, 5/20/89). The American Surgical Association states norms to control promotional activities of members lest they receive undue compensation from medical supply or pharmaceutical companies. (NEJM, 6/22/89). Prominent voices in health care comment concerning the erosion of trust that results from entrepreneurial activities of physicians and hospitals, (NEJM, 4/30/87). Will the aforementioned admonitions and norms be effective? Not if they stand alone. To create an ethical atmosphere in the corporate culture of health care, a renewed emphasis upon self-fulfillment through service to patients is needed. In a word, a sense of professionalism must be fostered in order to ensure that ethics leaves the realm of theory and becomes characteristic of everyday activities of health care professionals. In this essay we shall consider the meaning of professionalism and its implications for people in health care.
Professionalism requires knowledge. skill and empathy. The knowledge required to qualify as a professional varies depending upon one's role in the provision of health care. In the past, physicians were considered the only health care professionals but in the last century, nursing was recognized as a profession as well. In this century many additional occupations and services in health care have been recognized as professions because of additional knowledge of human physiology and psychology and the skills developed to apply this knowledge. In our day therefore several new professionals may be enumerated in the field of health care, for example, physicians assistants, respiratory therapists and health care administrators.
Clearly, acquiring the knowledge necessary for professional practice is not accomplished "once and for all." The need to continue learning even after having attained professional status is well recognized. Unfortunately many health care professionals confine continuing education to their own specialties. While emphasis upon improving scientific knowledge is laudable, some effort to advance in humanistic knowledge is also useful if one is to progress as a professional.
The skills associated with a profession are designed to utilize effectively the knowledge proper to that profession. In the United States, the effort to acquire knowledge and skills simultaneously is highly developed in the health care professions. All health care educational programs feature clinical experience as an integral element.
While knowledge and skill are important, the distinguishing characteristic of any profession is empathy; or the ability "to get inside" the patient or client. Empathy is defined in Webster as "the capacity for participation in another's feelings and ideas." Professions are distinguished from trades, crafts, or commercial occupations by reason of the need for empathy. A tradesman or artisan, for example a plumber or electrician, can perform his or her service even if he or she knows nothing about the person who requested the service. The knowledge and skill of the plumber or electrician ensures that a building will have water and electricity. While the people who utilize the building may benefit from the ready supply of electricity and water, the person installing or repairing the electrical or plumbing equipment need never contact the persons living there. Professionals on the other hand must know their clients intimately in order to accomplish their goals. They help people strive for goods which require cognitive and affective function on the pert of the client. Professions are directed toward helping people achieve goods which are fundamental and at the same time esteemed because they are goods which bespeak our humanity. Health, for example, is one of the basic goods of human life. Without health we have a difficult time performing these actions which are an expression of the fullness of our humanity. Pursuing truth or building community are two endeavors by which one measures one's humanity. Cannot one pursue these goods more effectively if one is healthy?
The extent to which empathy is neglected in contemporary society was evidenced in a recent column by Tom Peters.(Chicago Tribune, 6/19/89). Peters, co-author of In Search of Excellence , the "bible" for developing effective business organizations, emphasizes the importance of values. But he recently admitted that he had neglected to stress the need for empathy in developing value-centered people who will develop value-centered organizations. As Peters states: "(Empathy) is a simple notion, but it is the most complex and operationally the most difficult among the principles that all successful institutions observe. There is nothing patronizing or condescending about empathy. It requires a depth of sensitivity that allows one to sense other people's needs, often before they themselves articulate them." Peters concludes: "I am still at a loss as to how to be prescriptive about empathy, but the term will never again be far from my lips."
Even though Peters may be hesitant about being prescriptive in this matter, a few observations about developing empathy are in order. Empathy must be based upon a desire to share one's gifts with other persons. The gifts a professional possesses are knowledge and skill concerning the attainment of an important human good. Being a professional is sometimes described as an altruistic endeavor. In one sense this is true; being a professional is being "for others." But in another sense, being a professional is self-fulfilling because it enables people to "love others as they love themselves."
The second basis for developing empathy is respect, acceptance and reverence for other people. Before one can cultivate the ability "to participate in another's feelings and ideas," one must have a recognition of the person as "another self." This concept of empathy offers an understanding of why the profession of health care brings out the best in people, and why adequate health care is fundamental to developing a beneficent society.
Norms indicating the ethical manner to conduct oneself as a health care professional are useful. But they will not be observed unless individuals have a personal commitment to being professionals in the full sense of the term. Being a professional means more than earning a degree or possessing knowledge and skills. It also requires an ability "to get inside another person."
Kevin O'Rourke, OP
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