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Cover Focus | Mar/Apr '21

Updating the Definition of Professionalism

Rethinking the standards for professionalism for the next generation of physicians.

In 2020, a dialogue commenced on the concept of professionalism among female physicians, in part sparked by the since-retracted paper that started the #medbikini movement on social media. The study, “Prevalence of unprofessional social media content among young vascular surgeons,” was published in the Journal of Vascular Surgery and later retracted by the editors of the journal.1 In response, physicians across social media shared pictures of themselves in swimwear, challenging the notion that such images are somehow inappropriate.

In light of this movement, two female physicians shared with MillennialEYE their thoughts on what it means to be “professional” and how the concept of professionalism among women can be redefined.

1. Hardouin S, Cheng TW, Mitchell EL, et al. RETRACTED: Prevalence of unprofessional social media content among young vascular surgeons [retracted in: J Vasc Surg. 2020 Oct;72(4):1514]. J Vasc Surg. 2020;72(2):667-671.

JESSE BERRY, MD

This is certainly a timely and critical question that we all must face. To me, the issue is not about professionalism. We can all agree that there must be professional standards in medicine. In fact, it’s one of the Accreditation Council for Graduate Medical Education’s core competencies for training. Treating patients and colleagues with respect, compassion, and integrity is a big part of professionalism. Personal accountability and even professional dress come into play. There are, and should be, standards.

This discussion is more about the quick jump to labeling certain behavior as unprofessional, which was highlighted by the #medbikini movement. None of the women deemed to be unprofessional by the (presumably well-intentioned) authors of the study showed up to clinic in a bikini. They didn’t perform rounds in a bikini. They didn’t give lectures in a bikini. They wore bikinis during their off-duty time. And due to our cultural norms and implicit biases, a man wearing swimming trunks wouldn’t face this same criticism. A woman in a bikini may be seen as sexy, which often is equated to being “inappropriate” or “offensive” and thus “unprofessional,” whereas a man in swimming trunks may be seen as recreational. If he’s sexy, that’s often viewed as a plus, not a detriment. Men can be both sexy and serious; however, our culture still struggles with whether we think women can be both. (Clearly, I think they can!).

Rather than changing our professional standards, I hope we can instead be mindful of what we deem to be unprofessional behavior. I consider myself a highly professional physician who treats rare diseases. My research is funded by the US National Institutes of Health. I lecture all over the world, though I have never once done so in a bikini. I have, however, frequently worn a bikini on vacations and (gasp) even enjoyed a cocktail now and again. This doesn’t make me unprofessional; this makes me a normal human. The sooner we accept and normalize the fact that female doctors are also humans who have lives and families and bear children and wear swimwear on vacations, the sooner we will achieve a more accepting, productive, and, dare I say, professional, work environment.

Jesse Berry, MD
  • Associate Professor of Ophthalmology, Clinical Scholar, and Associate Director of Ocular Oncology at Children’s Hospital Los Angeles and USC Roski Eye Institute
  • jesse.berrymd@gmail.com; Instagram @_moda_mdand Twitter @_moda_md

DAGNY ZHU, MD

Three male surgeons went undercover to stalk the social media accounts of vascular surgery trainees to find content that they deemed unprofessional. How could a study using a highly subjective assessment of professionalism with predominantly male authorship not be wrought with unconscious bias?

Indeed, the “inappropriate/offensive” attire identified by the authors was limited to female surgeons in their off-hours wearing vacation swimwear. In making these assessments, the authors were asserting that a female physician’s attire outside of work was intimately connected to her qualifications as a medical professional within the clinical setting, as if a woman who wears a bikini on the beach would be a less skilled surgeon, have less passion for her work, or be less able to deliver the best possible care to her patients.

Women have been heavily judged based on physical appearance in and out of the workplace throughout history. If we are to promote professionalism in medicine, there is no room for double standards.

To me, professionalism in medicine is possessing expert skill and knowledge while displaying strong personal integrity and respect for oneself and others at all times. Sharing our lives outside of medicine does not go against that; in fact, it should be embraced. Professionalism is no longer the antiquated image of a one-dimensional, homogeneous, super-being in a white coat. Physicians today come in a variety of ages, genders, and races, from an array of cultural backgrounds, and should no longer be portrayed as one-size-fits-all. Many of us share our lives outside the white coat to inspire the next generation of trainees and to better connect with our patients, many of whom appreciate having a relatable doctor with interests and hobbies outside of medicine.

What must change is not what female physicians share or wear on social media, but how patients and fellow colleagues believe a physician should look or act. To change that perception, we need to continue advocating for diversity in the workplace, especially in leadership roles. We need to embrace our passions outside of medicine, and we must not be afraid to show what brings us joy. At the same time, we must self-reflect and become aware of our own unconscious biases. It’s time to redefine professionalism and evolve along with the changing faces of our profession.

Dagny Zhu, MD
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Mar/Apr '21