Medical professionalism is one of the key components of the doctor’s toolkit, and comprises technical expertise, interpersonal skills, time management skills, and medical competence. Clinical excellence cannot be achieved unless a doctor has high personal values such as altruism, empathy, respect for human life and good conduct (1). Professionalism can be defined as a set of attitudes and behaviours that serve as the foundation for services rendered by an individual towards society (2). Six components of medical professionalism have been suggested: excellence, self-denial, accountability, duty, rectitude, and respect (3). Empathy towards patients may be defined as the ability to understand a patient’s perspective and support him or her (4). Scholars have concluded that empathy may diminish among doctors due to their mistreatment by seniors and impersonal associations with patient subjects during their time at medical school, which is a threat to their professionalism and the overall quality of healthcare (5).
Medical professionalism is a belief system in which professionals promise to uphold in their work an adherence to ethical principles and respect for human diversity (6, 7). Lack of professionalism is connected to irresponsibility, procedural errors, conflict within medical teams, and concerns about profit (8). International studies have demonstrated that professionalism is an important quality when identifying a good doctor, along with technical and non-technical skills (9).
The health services in wealthier countries have progressed away from a traditionally paternalistic approach towards a more patient-centred and egalitarian, collaborative approach to doctor-patient relationships (10). However, healthcare providers, specifically medical doctors in public health systems, in developing countries such as Pakistan have been resistant to accepting the validity of modern approaches towards determining the doctor-patient relationship (11). This is associated with the declining medical professionalism among doctors in their early years of professional service.
There has been some debate about the quality of medical graduates over the last two decades and the medical professionalism of young doctors serving in public-sector hospitals in Pakistan. Previous studies on medical professionalism in Pakistan have focused on the qualities a good doctor should possess and have demonstrated that the medical community is trying to respond to this lack by means of conserving, researching, teaching, and evaluating professionalism (12, 13). Young medical graduates have socially constructed attitudes of superiority to other professions, because only the highest performing students in the education system become doctors in Pakistan. Familial pride is associated with their high-performing children when they succeed in qualifying for medical school. This generates a sense of superiority among both medical students and practitioners. The behavioural problems among doctors is also linked to an absence of professional spirit directed towards serving humanity, stubbornness about accepting other points of view, the subjectivity of human nature and breaches of the Hippocratic Oath (14). Furthermore, structural problems such as long working hours, low salaries, and unfavourable working environments have adversely affected medical professionalism.
In developed countries, medical graduates are well trained in using human and professional skills to deal with patients in an empathetic manner (15). However, there is huge variation in the standard of professionalism in developed and underdeveloped countries (16). On the one hand, professional spirit is declining among doctors and, on the other, the previous high opinion of the medical profession among patients is also going through a regressive change.
Scholars have been devising means of improving the professionalism of doctors through teaching additional courses as part of the formal curriculum and introducing training sessions on humanism in medicine. Klemenc-Ketis and Kersnik (17) have experimented with the use of movies to increase the level of professionalism among medical students by depicting ideal situations involving positive behaviour and scenarios of rich resource settings.
In Pakistan, students who demonstrate extraordinary academic performance and are positioned at the top of the merit tables are recruited into the medical profession. After working hard for many years, they remain unpaid or underpaid (18). The struggling doctors in Pakistan are protesting peacefully about the causes of low payment, hectic work schedules and job insecurity (19, 20). Abbasi (18) highlighted that the problems faced by doctors adversely affect the experiences of patients and lead to the departure of highly capable medical doctors from Pakistan. The prolonged suffering, delayed provision of medical care facilities, potential loss of health, lack of job security, unpaid service, and non-recognition of services rendered are the factors associated with strikes by young doctors.
Like other areas of public health, professionalism has also not been extensively explored in Pakistan. Up to now, only one study has focused on professionalism among medical students in Pakistan (12), but no previous work is available that examines professional behaviour among young doctors. Hence, this study aims to: (i) understand the perceptions of young medical doctors regarding how professional they are and how they perceive the structures, processes and outcomes that affect their medical professionalism; (ii) explore the patterns of declining medical professionalism among young doctors in Pakistan; (iii) depict the problems of young medical professionals that hinder their ethical performance, and hence to make result-based recommendations.