Professionalism in Pediatric Medicine: Why We Must Get It Right

A talented junior attending physician on a high acuity service is impatient on rounds and visibly irritated by nursing concerns, making trainees and team members uncomfortable and anxious about speaking up.

A senior medical researcher pushes the limits on deadlines for important grants and requests for proposals with his team, overcommitting to mentor gifted research fellows, lacking prompt communication, and causing team dysfunction in a critical and normally very productive lab.

A family that is very late to a primary care appointment is asked to reschedule. They become irate with the front registration staff, having missed work, and then a bus, to try to make the appointment. A primary care physician agrees to see the patient and family, though it may keep him over his normal clinic time.

The three cases above are disparate in their content but contain a common thread — in the intellectually challenging and demanding work of modern pediatric medicine, a mastery of science alone will not suffice to provide high-quality, safe and ethical care. Re-reading those cases we may ask ourselves, “What are the downstream effects of physician behavior on clinical care beyond the incident described? What impact might such behavior have on the public trust?”

Professionalism’s Latin root suggests that medical professionals “declare openly” our commitment to certain internalized values, what both “the public and individual patients can expect regarding shared competency standards and ethical values,” says Wynia et al. The American Board of Internal Medicine identifies these values in the primacy of patient welfare, patient/family autonomy and social justice.

The moral commitments of professionalism are deeply integrated into both the history of medicine and bioethics. And they are rooted in the practitioner-patient relationship. The family and patient are sick and need the doctor’s humane and competent skill; the practitioner agrees to hold that trust, deepen it and make visible the dignity of every child and family. This is heavy: professionalism is not “fluff” or an addendum to good medicine. It is central to the act of healing.

Impact on Quality and Safety

Beyond professionalism’s serious moral obligations, data shows that unprofessional behavior (even mundane infractions) can have a deleterious effect on quality and safety of patients. The Joint Commission summarized: “Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care, and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.”

Unprofessional behavior has even been shown to have a negative effect on clinician’s diagnostic and procedural performance. When physicians are unprofessional toward nursing staff, as shown in studies from Riskin et al. and Saxton et al., it can lead to increased nursing medical errors and decreased staff retention.

Bhardwaj’s persuasive data analysis from 2022 shows that drivers of unprofessional behavior can be broadly divided into two categories: 1. (lack of) self-care (e.g., burnout, life stressors, substance abuse) and 2. institutional culture (e.g., inadequate supervision, unsupportive work environment/leadership, resource constriction).

This is why our team is continuously making professionalism part of the institutional culture. As a world leader in the care of children, known for our Zero Hero culture of safety, we can, together, make excellent even better, and set the gold standard for medical professionalism as we have for so many other things.

Promoting Professionalism

First, we must intentionally practice virtue. At the heart of professionalism is a commitment to habitual moral practice and improvement. We must actively seek feedback, recognize our shortcomings, build on our strengths and remember that what we do is for the vulnerable children and families in our community. This is an internal process that results in tangible actions raising the dignity of every child.

Second, we must take wellness and self-care seriously. These are not mere buzz words. Physician burnout causes unprofessional care, and unprofessional care causes patient safety incidents, as shown by Hodgkinson et al. We should have a plan of how to recoup what our strong commitment to ameliorate the suffering of our patients and families will take from us, whether utilizing institutional resources or our own.

Third, we should make use of opportunities to bolster our understanding of professionalism, and then, to practice it. While Nationwide Children’s has an array of resources for faculty and staff, here I will highlight two that I believe are revolutionary and rare in pediatric care. Nationwide Children’s recently trained 14 faculty members in its inaugural Faculty Coaching Program, under the Center for Faculty Development. In this non-punitive, longitudinal, relationship-building and reflective process, a faculty member can be referred or self-refer for help in enhancing or correcting professional behaviors over 6 months. By holding faculty accountable to excellence in professional behavior while still affirming the gifts that make them essential to our institution, the Faculty Coaching Program uses self-directed insights to build skills with a trusted coach on an executive coaching model.

In my role as director of Faculty Professionalism, faculty with more serious professionalism issues are referred to me, and we develop a working relationship centered around accountability, transparency and remediation. I work closely with Chief Wellness Officer Brandon Kozar PsyD, MBA, because many professionalism issues are also wellness issues.

Finally, we must recognize those very rare occurrences when unprofessional behavior moves beyond coaching or remediation and crosses the line into the illegal, the unethical or the demeaning. We must then have insight to recognize threats to the patient, the institution, the profession or even society. This involves courage — the courage to speak up (even anonymously), utilizing available resources to quickly and ultimately stop such behaviors.

This article appeared in the 2026 Spring/Summer print issue. Download the issue here.

References:

1. ABIM Foundation; ACP-ASIM Foundation; European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Annals of Internal Medicine. 2002;136(3):243-246.
2. Bhardwaj A. Medical professionalism in the provision of clinical care in healthcare organizations. Journal of Healthcare Leadership. 2022 Oct 26;14:183-189.
3. Hodkinson A, Zhou A, Johnson J, Geraghty K, Riley R, Zhou A, Panagopoulou E, Chew-Graham CA, Peters D, Esmail A, Panagioti M. Associations of physician burnout with career engagement and quality of patient care: systematic review and meta-analysis. BMJ. 2022 Sep 14;378:e070442.
4. Joint Commission, Sentinel Event Alert. Behaviors that undermine a culture of safety. Issue 40 (July 9, 2008). Updated 2021.
5. Riskin A, Erez A, Foulk TA, Kugelman A, Gover A, Shoris I, Riskin KS, Bamberger PA. The impact of rudeness on medical team performance: A randomized trial. Pediatrics. 2015 Sep;136(3):487-495.
6. Saxton R, Hines T, Enriquez M. The negative impact of nurse-physician disruptive behavior on patient safety: a review of the literature. Journal of Patient Safety. 2009 Sep;5(3):180-183.
7. Wynia MK, Papadakis MA, Sullivan WM, Hafferty FW. More than a list of values and desired behaviors: a foundational understanding of medical professionalism. Academic Medicine. 2014 May;89(5):712-714.

Image Credits: Nationwide Children’s