Doctors and hospital infection prevention – is medical professionalism the solution or the problem?

Gwendolyn L Gilbert1, Ian Kerridge1,

1 Centre for Values, Ethics and the Law in Medicine and Marie Bashir Institute for Emerging Infections and Biosecurity, University of Sydney, NSW 2006 (lyn.gilbert@sydney.edu.au)

There is ample evidence that doctors comply relatively poorly with hospital infection prevention and control (IPC). Many strategies can improve performance temporarily, but rarely achieve sustained behaviour change. In this study we interviewed senior medical consultants at a Sydney teaching hospital to gain insight into their attitudes to, and perceptions of, doctors’ roles and responsibilities in healthcare-associated infection (HAI) prevention. “Medical professionalism” is, prima facie, a potential framework for improving doctors’ practices, for patients’ benefit, but analysis of interview transcripts suggests that some aspects of medical professionalism are barriers to, rather than incentives for, compliance with IPC protocols. Specifically:

  1. Participants noted that doctors’ privileged professional autonomy and their ‘right’ to make independent judgments, based on clinical experience – meaning that they could justify disregarding “rules”, themselves, often whilst acknowledging the need for compliance (by others).
  2. While all participants noted the importance of senior leadership in training junior doctors in the “rules of the game” they disagreed about whether senior consultants were more likely to be positive or negative role models for IPC compliance or whether junior doctors are more likely to be aware of, and comply with, IPC protocols.
  3. HAIs become the focus of doctors’ attention only when they cause serious, identifiable, proximate mortality or morbidity; HAI prevention and adherence to IPC protocols are regarded as of limited interest and relevance or ‘nurses business’.
  4. Many doctors have limited cultural commitment to the (public) hospitals in which they work or, therefore, to organisational responsibilities, like IPC. Many believe that hospitals don’t value their work; they have no control over budgets, work practices, operating lists or even patient care. As one participant said: ‘they have no ”skin in the game”’.

Conclusion: Our results suggest that “medical professionalism” works against IPC adherence because it focuses mainly on the profession, itself, and doctors’ relationships with individual patients, and less on doctors’ role in, and responsibilities to, the (hospital and wider) communities they serve. A critical examination of doctors’ roles in IPC illustrates how “medical professionalism” is not synonymous with ethics in health care.


Biography

Lyn GIlbert is an infectious diseases physician with a particular interest in prevention and ethics of communicable diseases of public health importance, including healthcare-associated infections