Celebrating 10 Years of the Physician Charter on Medical Professionalism

The American Board of Internal Medicine (ABIM) Foundation joined the American College of Physicians (ACP) Foundation and the European Federation of Internal Medicine in 2002 to produce “Medical Professionalism in the New Millennium: A Physician Charter.” Translated into 12 languages, the “Physician Charter” has been endorsed by more than 130 organizations worldwide, including ASN, during the past decade.

The medical profession faces a proliferation of technology, fluctuating market forces, health care delivery challenges, and globalization, the Physician Charter observed 10 years ago. “As a result, physicians find it increasingly difficult to meet their responsibilities to patients and society,” stated the charter. “In these circumstances, reaffirming the fundamental and universal principles and values of medical professionalism, which remain ideals to be pursued by all physicians, becomes all the more important.”

As a guide to help physicians understand their professional responsibilities to individual patients and society as a whole, the charter focuses on three fundamental principles:

Primacy of Patient Welfare. “The principle is based on a dedication to serving the interest of the patient. Altruism contributes to the trust that is central to the physician-patient relationship. Market forces, societal pressures, and administrative exigencies must not compromise this principle.”

Patient Autonomy. “Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients’ decisions about their care must be paramount, as long as those decisions are in keeping with ethical practice and do not lead to demands for inappropriate care.”

Social Justice. “The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, socioeconomic status, ethnicity, religion, or any other social category.”

“For the past 10 years, the Physician Charter has provided a framework for ensuring the personal commitment of physicians to their patients as well as our collective effort to improve health care and benefit society,” said Donald E. Wesson, MD, FASN, who chairs the ABIM Foundation Board of Trustees. “Together, medical professionals, including nephrologists, and society must clearly understand the principles and responsibilities of medical professionalism,” added Dr. Wesson, who also serves as ASN Secretary-Treasurer. More than any external incentives or disincentives, according to Dr. Wesson, “actions driven by values internal to physicians, outlined in the Physician Charter, will help us successfully navigate through the crises facing modern medicine to improved and maintained health of the public that we have the privilege to serve.”

Commitment to medical professionalism

The Physician Charter articulates 10 professional commitments of physicians and health care professionals, including improving access to high quality health care, advocating for a just and cost-effective distribution of finite resources, and maintaining trust by managing conflicts of interest. The charter also includes a “commitment to professional competence” that states: “Physicians must be committed to lifelong learning and be responsible for maintaining the medical knowledge and clinical and team skills necessary for the provision of quality care.”

“ASN contributes to this commitment to professional competence by helping ABIM develop practice improvement modules, offering the Board Review Course and Update, producing the Nephrology Self-Assessment Program (NephSAP), and providing opportunities for continuing education credits to physicians and other health professionals,” said ASN President Bruce A. Molitoris, MD, FASN. “Helping nephrologists maintain professional competence is core to ASN’s mission.”

Dr. Wesson noted that several of the challenges to medical professionalism the Physician Charter identified still remain present 10 years later: “We need to address growing disparities among the legitimate needs of patients, bolster available resources to meet those needs, harness the power of market forces to transform health care systems, and help physicians maintain their traditional commitment to the primacy of patients’ interests.”

Since 1999, the ABIM Foundation has been “working towards improving health care through the advancement of medical professionalism.” To accomplish this goal, the foundation promotes “organizational and policy forces to advance professional values and behaviors,” learns from international comparisons, engages physicians in advancing care, and supports new competencies to improve quality.

For example, the ABIM Foundation partnered with Consumer Reports and nine specialty societies, including ASN, on April 4, 2012, to launch the “Choosing Wisely Campaign.” Each society identified “Five Things Physicians and Patients Should Question” to help initiate conversations between physicians and patients about the actual need for many frequently ordered tests or treatments. ASN’s contribution to the “Choosing Wisely Campaign” is available at http://www.asn-online.org/policy/choosingwisely/. More than 20 societies are scheduled to join the campaign in 2013.

To learn more about “Medical Professionalism in the New Millennium: A Physician Charter” or the ABIM Foundation, please visit http://www.abimfoundation.org/.

December 12 (Vol. 4, Number 12)