Professionalism and the Shift Mentality

Abstract

The Halstedian tradition imbued the art of surgery with a deeply rooted sense of re-sponsibility and a powerful work ethic. As apprentice surgeons, junior residents gained reputations for professionalism when they immersed themselves in patient care so deeply and for such long periods that they owned their patients. No detail of patient care was so trivial that it could escape the effective intern. The introduction of strict limits on resident work hours brought many positive changes to training programs nationwide. An unintended consequence of this policy is the potential for the loss of patient ownership by trainees. Patient ownership is the philosophy that one knows everything about one's patients and does everything for them. It is a central tenet of surgical professionalism dating back decades and is fundamental when facing critical patient care decisions. The shortened duty periods and subsequent frequent transfer of responsibility to others pose a challenge to the trainee's sense of professionalism and the continuity of patient care. This challenge must be addressed head-on. Residents must learn a New Professionalism that stems from sharing responsibility for the care of their patients. They must be given a new understanding of their responsibilities, new methods for organizing and sharing patient information, and new skills for directing team-based care as they work toward competency in systems-based practice. Residents, particularly junior residents, may lack many of these skills. The craft of conveying pertinent patient data to permit team-based care must be learned, just as all other forms of clinical communication are learned. And the unwillingness to relinquish patient ownership-the deep-seated desire to say, Nothing to do, I'll grab a nap and be back in a couple of hours-must be unlearned.