The professionalism of general practitioners (GPs) is a major contributor to general practice being considered one of the most trusted professions by the community at large.1,2 The maintenance of individual professional standards protects the reputation of the profession as a whole and is considered as important as high standards of medical care.3,4 However, one of the significant challenges facing GPs when discussing professional and ethical behaviour is that there is no simple definition of this. Being ‘professional’ is not a technical or simple skill to learn and assess through a series of checklists.5 Professional and ethical behaviour needs to be adapted to the circumstances and embraced as complex and multidimensional. GPs need to consider what the core issues of professionalism are for each context; for example, ensuring that the patient’s health-related interests remain the primary concern,6 and then expand these to logically detail the professional and ethical principles relevant for the situation.7
For centuries, doctors, including GPs, have had a social contract with the community. In return for status and financial rewards, clinicians meet the needs of society through service and altruism.8 Professionalism is about upholding this social contract. It involves building trust between the GP and the patient. This includes intellectual trust, which is the GP’s commitment to scientific and clinical excellence, and moral trust, which is the commitment of GPs and healthcare organisations to protect and promote the health and interests of patients before other interests.6,7 This responsibility also includes treating all people, including patients, their families and carers, colleagues, and other healthcare workers, with dignity, courtesy, respect and compassion.3 GPs are also expected to display attributes such as integrity, truthfulness, commitment to patient safety, confidentiality, respect for cultural differences, self-awareness and reflective practice.9 The maintenance of appropriate patient–doctor boundaries is also required;9 however, this can be challenging for GPs when they are working in rural practice and need to provide healthcare to other GPs or close friends or neighbours. Maintaining boundaries is also a challenge in other areas, such as in the context of mandatory reporting or in the use of social media. Meeting high standards of ethical and professional behaviour increases patient trust and ultimately patient care, and improves workplace harmony, making it a vital element of general practice.1
As is the case with medical knowledge, professional values are not static and continue to evolve over time in response to societal demands and expectations.8,9 GPs are expected to continually develop their professional knowledge, skills and attributes throughout their career.9 This requires GPs to engage in self-reflection and identify and act on areas for development. They are also expected to acknowledge and learn from errors,10 and to engage in honest, open disclosure about adverse events.11,12
GPs can experience stress and isolation due to their career.13 Experiences of isolation are particularly common for those working in rural and remote areas, and those working in after-hours general practices. There are strategies to help mitigate the stress of being a GP, such as attending to physical and mental wellbeing and developing good self-care habits, and these are explored further in the Doctors’ health unit.
A GP’s personal awareness and reflection on their cultural identity impacts on clinical interactions and healthcare service delivery. This might be when interacting with Aboriginal and Torres Strait Islander peoples and people from culturally and linguistically diverse backgrounds, for example. GPs therefore need to actively identify and seek to address their own biases, judgements, assumptions and attitudes. Ongoing cultural competency training14 and partnering with Aboriginal and Torres Strait Islander peoples and healthcare workers from culturally and linguistically diverse communities is vital to meeting professional and societal expectations.
In addition to continuing to grow their own professional knowledge and skills, GPs might also be called upon to educate their peers and other health professionals and provide education for local community groups. Some GPs might be interested in acquiring skills to become GP supervisors or medical educators,15 and all GPs need to engage in patient education in their daily practice.