Beyond the Box: Focussing on Shared Humanity in Medical Professionalism

Abstract

The need to critically re-examine the professional norms we are demonstrating and teaching in medical education has gained traction in the published literature [1] and beyond. At a recent medical education conference, several plenary speakers discussed various aspects of professionalism and professional norms [2, 3]. These helped foster a number of more formal [4, 5] and informal conversations about different meanings of the term ‘professionalism’, its implications and the ever-present collisions at the estuary of medical culture, tradition, hierarchy and power, all evolving over time.

Current professional norms differ from place to place but generally provide a framework or guideline for physician (and trainee!) behaviour [6]. Issues arise, however, when the cultural norms on which professionalism are based do not reflect the norms and values of those working in the profession [2-5]. Focussing on and connecting on shared humanity—on those aspects that we all have in common and those aspects that make us wonderfully, brilliantly unique—could provide a very broad scaffold in which each individual physician could thrive. After all, there is more that connects us than separates us—and a focus on this is (or should be) the true professionalism of the medical profession.

Before launching into professionalism as a whole, we can first start by considering what, exactly, ‘shared humanity’ is. It is a term growing in popularity, but the nuanced differences in its meaning can vary from setting to setting. By shared humanity, in this article, I am referring, very simply, to the human existence that binds us all. We have more in common than different—differences, I might add, which are often socially imposed and perpetuated. We are all alive, living in the same world. We breathe the same air, rest on the same ground, feel the same sun.

If we focus on our shared humanity, on the myriad things that connect us, this allows the (often) socially imposed boxes that separate us to fade into the background. Consider the things that typically breed separation—or ‘otherness’. Why does it matter on what side of an arbitrary line in the sand one was born, or one lived, or one lives or one works, if we are here now, in this moment, together? Why does it matter what languages one speaks, if we can understand each other? Why does it matter by what name one calls God—or if one calls to God at all? Why does it matter what shade one's skin is, or one's hair colour, or hairstyle or outwardly projected appearance in general? Does that affect whether one is kind? Understanding? Patient? Knowledgeable? Can we focus on each other as individuals, brilliant and unique, without focussing on what separates us? Yes, tribalism (connection to a group, to the exclusion of others) exists in medicine [7]. Yes, there is belonging and comfort to be found amongst those with whom one perceives similarity. I am not arguing otherwise.

But does tribalism have a place in medicine? Or does it stand in the way of what might be called true professionalism—seeing each other first and foremost as individuals?

Let us consider this in more detail.

As the mixed-race child of two multicultural parents, cultural norms have always been in flux, more contingent on those surrounding me than on my presence. Hierarchy, power, tradition and culture were concepts I knew before I could articulate the words—and adaptation was an unspoken understanding. A religious gathering with one group of family, for example, was a very different affair from a religious gathering with another part of the family. Understandable, when one considers culture to be the product of social learning defining belonging a group [8].

And yet, growing up, our house—a sanctuary where adaptation was unnecessary—was a melting pot of foods, smells, accents, clothes, colours, … something undefinable by textbook classification, but uniquely us. Even now, I struggle to describe myself according to any one particular culture's norms. What word captures that phenomenon when cultures collide, creating something that does not fit into any particular group?

There are rooms where a melting pot is not welcome. Where a lack of culture, a lack of a box to fit into, breeds discomfort. There are crowds where one is more often defined by what is not than by what one is. Many who read this will share understanding.

However, the idea that medicine, with its increasing diversity, has given rise to a melting pot of its own is intriguing [4, 5]. I returned to work shortly after the final conference plenary talk. Within the space of a single morning, three separate individuals indicated to me that they had a clear idea of what a doctor should look/sound/act like—and I was not fitting the bill. Despite over a decade in the medical field, it is still not uncommon for me to hear that I am not a ‘real’ doctor, that a real doctor is, well, defined by some box I do not fit into.

And I have counselled many learners who have faced similar struggles.

Patients have a sense of what professionalism in medicine is. Naturally, this sense changes from room to room. From culture to culture. From person to person. And it is foolish to think the face of medicine could ever match the expectations of a mosaic of patients, cultures, backgrounds, beliefs and—yes—prejudices.

It is one thing to discuss professionalism within medicine. To discuss the need to focus on our shared humanity when interacting with patients, ignoring for a moment the problem of cultural norms within the diverse patient groups we face. Not everyone will see humanity when looking at a doctor. Such is the nature of medicine, where patients come to us at their worst, their most vulnerable. But we are also those patients, with our diverse backgrounds, cultures, beliefs and prejudices that follow us wherever we go.

Before we can expect others to see us for who we are, beyond the boxes we do and do not fit into, we need to see humanity when we look at each other. And this shared humanity, I would argue, should serve as a crucial component backbone for professional norms in medicine, providing a scaffold through which more profession-specific nuances can fall.

Tensions arise when students experience conflict between personal values and professional norms [9]. In the chaotic background of world events and politics, I have had many learners come to me, battling moral distress as they try to balance their duties to the profession with duties to humanity. They find themselves torn between advocacy for human rights and maintaining a ‘professional’ front, struggling to find the line between being an ‘acceptable’ advocate and being a ‘troublemaker’. By trying to walk the line between various cultures, traditions, and social norms, they find themselves walking no line at all, feeling inauthentic, and sliding into burnout, isolation, and disillusionment. I have heard the stories of learners whose interactions with others within medicine have left them feeling less than human. They are floundering within a culture, within a system, which fails to recognise their humanity. They have been rejected by the ‘tribe’.

And, perhaps, here lies the key. While it is debatable whether tribalism is inherent to human nature, it is indisputable that one cannot create a tribe without individuals. Medicine cannot operate without individuals. No culture or society can. Yet tribalism, reciprocally, erases the emphasis on the individual. And it is folly to think one person can influence the centuries of culture, tradition, hierarchy, and power that play into current professional norms (in the Western world).

Or is it?

In medicine, we are taught in early days to treat all patients the same, to put aside personal prejudices, biases and thoughts and to care for the patient in front of us as if they are the only person who matters.

Could not the same hold true for those who work in medicine as well? If we treat each physician, each learner, each other, as individuals we share humanness with, could this not create a different culture—a culture of shared humanity? Before we can speak about redefining professional norms, the culture of medicine—we need to learn how we, as individual humans, can reach across the divide towards other humans.

We are all struggling. We are all flawed. And, oftentimes, individual interactions, individual change, can feel like a drop in an ocean. But how else can change start, if not with one person?

As the child of a tree with roots spanning countries, continents, nations and peoples, I have always struggled to find a ‘fit’. To find a box that describes me. More often than not, I find boxes used by others for ‘othering’: to point out differences, rather than similarities. Some of the most interesting conversations I have had have been with other melting pots, a journey of discovery, connection, and learning.

And if I can apply this same curiosity, learning and connection to every person I meet, perhaps, this is the first step in finding my ‘professionalism’, walking a new path into a modern era of medicine.

B.T.B. Preti: conceptualization, writing–original draft, writing–review and editing.

The author declares no conflicts of interest.