INTRODUCTION

The Case for Continuing Professional Development in Professionalism

There are many “gaps” in clinical practice. The Institute of Medicine reports, and those from the Rand Corporation, provide a clear picture of the clinical practice gap: the failure to meet best evidence performance at the time of care. This phenomenon is complex and multicausal, the product of incomplete information, poor information transfer to and retention by the practitioner, poor patient compliance and understanding, and a host of other environmental or setting-specific issues.

This is not the only care gap however: gaps also exist in clinician conduct between what we would normally call professional behavior and those that occur in the real word of clinical practice. These gaps occur when physicians and others fail to follow the tenets of the “Charter on Medical Professionalism,” that is, demonstrate adherence to the principles of the primacy of patient welfare, patient autonomy, and social justice. These two elements, elsewhere described as the science and the art of medicine, contribute to patient's frustrations with health care systems virtually world wide.

The following are examples of the latter problem. They may be illustrative; they are certainly familiar:

• “Turfing”: this word denotes a patient transfer or triage from one physician to another when the care of that patient feels more troublesome than it is worth. A widespread phenomenon in medical training programs, turfing appears to allocate patient care to meet physicians' rather than patients' needs.

• Commercial influence: many examples exist in which professional educational products and physicians' practices themselves, including clinical practice guidelines and publications, have been biased by the involvement of commercial influences such as those in the pharmaceutical industry.

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