Ethics and Professionalism

Robyn V. Woidtke

According to the Institute of Medicine (1), sleep disorders and deprivation are considered a public health issue, and as such, sleep technologists not only need to understand professionalism from a personal perspective, but also need to have a sense of how professionalism is encompassed within the field of sleep medicine, as part of a health care organization and the public at large (2).

The field of sleep technology is changing. We now must include in our thinking such aspects of care as wearables (home apnea testing, consumer goods), social media, and incorporating person-centered care. However, our main focus remains unchanged; we watch and monitor individuals while they sleep. In addition, we have a responsibility to shepherd our patients through their therapeutic journey by educating and providing supportive care.

Unlike any other allied health care field, the role and duties of the sleep technologist establish an interesting and unique relationship with patients. The profession is based on an intrusion into a facet of life where few are allowed to enter, with the exception of an occasional health care provider, family, and bed partners. Since patients who are undergoing a sleep study place them in a vulnerable situation, that is, they are sleeping, professional conduct cannot be emphasized enough. Accordingly, patient privacy and welfare must be considered at all times. This fact alone requires additional insight and mindfulness into how we conduct ourselves professionally and ethically. For all health care professionals, conducting themselves with the highest moral and ethical standards and performing their jobs with the utmost care should be paramount (3).

When considering what it means to be a “professional,” one might contemplate levels of education, stature within the community, membership in an organization, or employment. These domains are further influenced by culture, personal background, religion, life experiences, and moral and ethical foundations. Being a “health care professional” should optimally include tenets of professionalism. The term professionalism takes many forms and can be expressed in many ways. Nevertheless, most of the definitions embrace the foundation of professionalism, which is formed against a backdrop of trust and putting the patient first (4). This term is also encompassed in standards, certification, and licensure (5).

A recent article by Wynia et al. (6) discusses that professionalism is more than just a list of preferred attributes and behaviors to be checked off or measured. They suggest that the goal of professionalism is “ensuring that health professionals are worthy of patient and public trust.” They further discuss that the basis of such lists, while they exist, are extensions of the fundamental beliefs that come with the medical profession.

The constructs of professionalism range from simple personal attire to the complex realm of moral and ethical principles. Professionalism can be as uncomplicated as the way by which we greet a patient coming to the sleep disorders center or as multifaceted as our ethical responses to difficult situations; in essence, it is the “social contract” of the conduct of professional interactions, whether a colleague, patient, or family member.

PROFESSIONAL AND HEALTH CARE ORGANIZATIONS

Professional organizations or associations exist for almost every type of group, from craftspeople to the health professional. Nevertheless, the majority of medical professional organizations have no legal jurisdiction, and thus practice under a “self-governing” structure (7). The American Medical Association (AMA) discussed the importance of medical associations as the following: “their conferences, continuing medical education courses, practice guidelines, definitions of ethical norms, and public advocacy positions carry great weight with physicians and the public” (8). It is important to realize that the organization or association is there to protect not only its members but also the public. Moreover, while the AMA does not specifically address the associations in allied health fields, theoretically the same applies.

A professional organization is created by and for people who have a common interest to come together for a common goal, a community. Research indicates that most professional organizations begin with a small core group of committed and enthusiastic individuals in an informal meeting. The ad hoc informal meeting generates a desire to create and carry on a more formal organization. As the organization begins to take form, it begins to define the scope of the profession, standards of practice, and professional guidelines and to create opportunities for education and camaraderie (9).

Hence, the organization provides the foundation from which the profession matures and develops. Although the organization provides an infrastructure that defines the profession, it is up to the individual to remain professionally competent, a component of professionalism. This is accomplished through continuing education, recertification, or ongoing demonstration of competency and daily on-the-job conduct.

Egener et al. (10) state that health care organizations also have a duty to their employees and the public to ensure that professionalism is at the core of its mission. They further state that lack of clarity at the organizational level impacts the ability of the physician to follow the 2002 medical professionalism charter. Organizational professionalism has also been demonstrated to improve the physician moral, improve the trust of the people, and improve the safety and quality of care (11).

WHAT IS PROFESSIONALISM?

The term professional connotes knowledge and professional behaviors that are known as professionalism. Brennan and Monson (4) state, “Professionalism is an indispensable element in the compact between the medical profession and society that is based on trust and putting the needs of patients above all other considerations.” The sleep technologist must have a fundamental belief that this statement is also true for them and be able to integrate this type of thinking into their professional lives.

The National Board of Medical Examiners (12) has a program directed toward education and evaluation of professional behaviors. To that end, they have developed specific criteria of professional behaviors. Table 70-1 lists the behaviors and gives examples of how those behaviors can be exhibited. As noted earlier, lists are not something just to be checked off but can be used to teach and provide an opportunity to review personal values and conduct.

Although everyone in every profession should exhibit professionalism, it is imperative that the health care professionals practice behavior that is above reproach. They must not only be aware of their own morals and values but have the ability to separate their personal beliefs from their field of practice when cultural and religious values differ from their own, which includes patient autonomy and the right of patients to make their own decisions (13). In some instances, this may create inner conflict, but they must still behave in a professional manner while conducting their jobs.

The fundamental principles of professionalism, as published in 2002 in the Annals of Internal
Medicine, are primacy of patient welfare, patient autonomy, and social justice (14). These principles go hand in hand with such responsibilities as commitment to professional competency, honesty with patients, patient confidentiality, appropriateness of relationships, improving quality of care, and improving access to care.

Table 70-1 Categories of Professional Behavior with Examples

Altruism	Contributes to the profession; helps others in the workplace
Honor and integrity	Forthcoming with information; does not withhold information for power; admits errors
Responsibility and accountability	Accountable for deadlines; arrives on time; takes responsibility for their share of the workload
Excellence in scholarship	Masters techniques and technologies in learning; has internal focus and direction; setting own goals
Respect	Respects patients and staff; demonstrates tolerance for a range of behaviors and beliefs
Leadership	Teaches others; perpetuates a culture of professionalism
Caring and compassion	Treats the patient as an individual; supports a balance between work and home with peers and subordinates
Adapted with permission from the National Board of Medical Examiners.

Volunteerism, Social Media, and Leadership

Additional aspects of professionalism occur outside of our conduct within the sleep center. It is important for technologists to be active in their communities. Volunteering not only enhances their professional and personal growth but also provides another avenue to increase their visibility as sleep technologists within their local communities. By networking outside of their “sleep silo,” they are demonstrating to others that their profession is important, while creating a new awareness of the impact that sleep deprivation and disorders have on our society.

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