Professionalism in Pediatrics: Statement of Principles

Pediatricians and pediatric subspecialists occupy an important place in society as privileged and trusted advocates for the well-being of children. Within this environment, how should professionalism be defined, and what should it mean to the practicing provider? The purpose of this statement is to clarify the definition of professionalism in pediatric care and to translate these concepts into clinical practice. One of the unique aspects of professionalism within the pediatric context is the multilateral interactions of the child patient, the family, other health care and support services providers, and other pediatric professionals. The principles outlined here apply to trainees, pediatric training-program faculty, and private practitioners.

Educational initiatives in medical school curricula and continuing medical education for practicing pediatricians must include the principles and practice of professionalism. An appreciation of these concepts depends on an ability to define and assess professionalism within pediatrics.

On balance, the concept of professionalism in pediatrics is similar to that in other specialties in the field of medicine,^1–5  except that working with children creates unique circumstances that deserve special consideration. For example, an appreciation of the informed-consent process in pediatric practice requires the provider to consider how best to involve the child patient at a given developmental level into conversations and decision-making despite incomplete maturation. A definition of professionalism will include, but is not limited to, the principles set out by the American Board of Pediatrics as specific guidelines for the teaching and evaluation of professionalism as part of the core curriculum for residency training in pediatrics.⁶  These principles are:

• Honesty and integrity—embody the principles of fairness, the ability to meet commitments and keep one's word, and the duty to be intellectually honest and straightforward in interactions with patients and peers and in all professional communication.

• Reliability and responsibility—represent accountability to children, families, other physicians, medical staff, community, and ultimately society. They require acceptance of responsibility for errors made, including the willingness to acknowledge and discuss errors and their consequences with the family and with peers, and collaborate in the search for systematic actions to prevent future harm.

• Respect for others—involves treating all persons with respect and regard for individual worth and dignity, including sensitivity to gender, race, and cultural differences as well as maintenance of patient confidentiality when appropriate.

• Compassion/empathy—the ability to understand children's and family members' reactions to pain, discomfort, and anxiety from their point of view, not that of the physician.

• Self-improvement—involves a commitment to lifelong learning and education.

• Self-awareness/knowledge of limits—the maturity to recognize when a problem involves knowledge or technical skills beyond the experience of the provider and to ask for consultation or assistance in those situations.

• Communication and collaboration—involve the recognition that patients' families and the health care team must work cooperatively with each other and communicate effectively to provide the best patient care and appropriate community interventions, including home health services; rehabilitation services such as occupational, speech, and physical therapy; and school reentry.

• Altruism and advocacy—refer to the unselfish regard or devotion to the welfare of others. Patient well-being should be the primary motivating factor in patient care, ahead of physicians' own interests and needs.

The integration of values that emphasize not only individual rights and freedoms but the teamwork that is essential to the practice of medicine is key to achieving one's professional goals within pediatrics. These values include:

• Responsibilities to patients and families—refer to the collaborative relationship that involves pediatricians, patients, and parents, with recognition of appropriate boundaries in patient care, and promotion of the concepts of respect for privacy, nondiscrimination, and conflict resolution. Pediatricians should not refuse to care for acutely ill children on the basis of the ability of the family to pay for services rendered. However, practice overhead expenses preclude the provision of comprehensive health services for every child whose family requests routine or preventive health services unless there is some means of compensation. The American Academy of Pediatrics believes that the medical care of infants, children, and adolescents should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, culturally effective, and provided according to the medical home concept.⁷ 

• Responsibilities to other health professionals and health care and support services providers—entail treating each other and all other professionals, including individuals who provide ancillary services to patients, with integrity, honesty, and respect in daily interactions.

• Responsibilities to communities—refer to the collaborative relationship between a pediatrician and the wider community to address issues of advocacy for child health and effective use of health care and public health resources.

• Responsibilities to the profession—involve subscribing to and acting on the concepts of lifelong learning, willingness to teach and contribute to medical knowledge, engaging in self-care, treating one's team with respect, and communicating effectively; promoting the practice of medicine with integrity now and in the future; and working toward a system of medical regulation that combines professional, organizational, and patients' perspectives with a goal of strengthening the medical profession's accountability for its own performance.

This brief statement of principles emphasizes the core professional values that pediatricians and pediatric subspecialists should adopt and that will serve as an ethical foundation for quality health care for children and their families.

Douglas S. Diekema, MD, MPH, Chairperson

Armand H. Matheny Antommaria, MD, PhD

^* Mary E. Fallat, MD

Ian R. Holzman, MD

Steven R. Leuthner, MD

Lainie F. Ross, MD, PhD

Sally Webb, MD

Jeffrey L. Ecker, MD

American College of Obstetricians and Gynecologists

Marcia Levetown, MD

American Board of Pediatrics

Ellen Tsai, MD

Canadian Paediatric Society

Dena S. Davis, JD, PhD

^*Jacqueline Glover, PhD

Alison Baker, MS