Rovenstine Lecture: Professionalism requires a lifetime commitment


David Chestnut, M.D., presented ‘On the Road to Professionalism’ on Monday.

In a soul-searching Emery A. Rovenstine Memorial Lecture on Monday, David Chestnut, M.D., examined the key attributes of professionalism and his own journey on the road to professionalism in anesthesiology.

“Each of us helps shape the culture of professionalism in our practice environment. Professionalism is not something that we learn once. None of us is perfectly professional at all times in all circumstances. Professionalism is both a commitment and a competency that we practice over a lifetime,” said Dr. Chestnut, Professor of Anesthesiology and Chief of Obstetric Anesthesiology at Vanderbilt University, Nashville.

The key attributes of professionalism in anesthesiology include humility, leadership, self-awareness, kindness, altruism, attention to personal well-being, responsibility and concern for patient safety, lifelong learning, honesty and integrity, and self-regulation.

Professionalism is intangible, and competence in professionalism cannot be guaranteed in the same way as competence in central-line placement, he said.

“Arrogance and pride are self-destructive. Ironically, a person who possesses true humility does not have the slightest idea that she is humble. A humble person recognizes that she is not always right and accepts criticism graciously and gratefully. A humble person acknowledges her mistakes and is quick to apologize when an apology is needed. A humble person does not call attention to herself,” Dr. Chestnut said.

He said he learned about humility the hard way. Shortly after he was named chair of anesthesiology at the University of Alabama at Birmingham, he sent a memorandum to the faculty with a list of “platitudinous goals and slogans” for the department. Some faculty members perceived the memo as sanctimonious and self-serving.

The next morning, he got back a copy of the memo with a hand-written question: “What makes you believe any of us care what you think?” Respect is not an entitlement, he said. Respect must be earned.

In the bestselling book Good to Great by Jim Collins, the author wrote that the most successful leaders demonstrate a paradoxical blend of personal humility and professional will, Dr. Chestnut said.

“Such leaders display modesty and are self-effacing and understated. They do not talk about themselves,” he said. “Rather, they talk freely about the organization and the contributions of others.

“As leaders of the perioperative team, we have the unique opportunity to create a collegial and mutually supportive work environment. We can and should encourage the staff with whom we work. We should learn their names, treat them with respect and express gratitude for their work.”

Leaders in anesthesiology need emotional intelligence and self-awareness, as well as good interpersonal skills that foster trust and confidence among the staff. Leaders also need to be kind.

“Few definitions of professionalism include kindness as an essential attribute, but the older I get, the more I value kindness among colleagues and staff,” Dr. Chestnut said. “Sadly, a singular focus on career success often erodes a person’s kindness.

“Candidly, I became a more unkind person during my 11 years as a department chair. Over time, my interactions with patients became more impersonal. One day I prepared to perform a pre-anesthetic assessment on a woman who was scheduled to undergo surgery for breast cancer. Her surgeon was in the room talking with her. I became annoyed when one minute stretched into five and then 10. I had other things to do. What were they talking about? Then I realized that she was crying, and the surgeon was speaking and listening with an empathy that put me to shame.”

He emphasized the importance of interacting with patients before surgery to foster human connections. He listed a number of personal questions he asks patients during an assessment, including what the patient prefers to be called, where he or she is from and what questions the patient may have.

At the end of his lecture, the audience gave Dr. Chestnut a standing ovation.

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