The Unbearable Vagueness of Medical ‘Professionalism’

When Joel Bervell thought about professionalism as an undergrad, he thought of “Grey’s Anatomy.” Specifically, he thought about how residents on the show were expected to be, although often were not: on time, prepared for their cases and respectful to everyone around them.

“That was the only standard that I had of what it meant to be a doctor — especially someone like me, who doesn’t come from a family of doctors,” said Mr. Bervell,28, a fourth-year medical student at Washington State University. Mr. Bervell, who is Ghanian American, is one of the first Black medical students at the medical college, which opened in 2017.

From the moment students set foot in medical school, they are instilled with the concept of medical professionalism: their sacred responsibility to conduct themselves with the values of a profession that is granted automatic trust in society. “It is the first thing they tell you: You are now literally a medical professional,” Mr. Bervell said.

The same metric can be used to determine whether or not a med student becomes a doctor at all.

Starting in their third year, Mr. Bervell learned, he and his classmates would be regularly assessed on their professional behavior, along with other attributes like communication skills. Faculty, staff and other students could also report specific concerns about an individual’s professionalism, resulting in write-ups the contents of which could become attached to their permanent records, following them like scarlet letters.

The problem, as many medical students have also learned, is that where “professional” is vague, “unprofessional” is even more so. Depending on who makes the call, unprofessional behavior can mean hugging your program director, letting a bra strap show, wearing braids, donning a swimsuit over the weekend or wearing a “Black Lives Matter” sweatshirt in the E.R.

As a result, professionalism exists at two levels, as both a lofty standard of behavior and a (sometimes literal) list of dos and don’ts that blur ethics and appearance. That second meaning can prove particularly pernicious to residents of color, said Dr. Adaira Landry, an adviser at Harvard Medical School and co-author on a recent journal article on the “overpolicing” of Black residents.