“If I want to get plastered on a Saturday night, and fight on my High Street,” a surgeon told me about 12 years ago, “ I can.”
At that time I took issue with his view, my lofty beliefs then suggesting that professionalism was something we were, part of our identity and not just something we put on of a Monday morning; That we had an identity to uphold, service users to support, public trust to maintain.
Now, I am not so sure. Now I fear that professionalism is no longer seen to be something that individuals develop but rather a set of robotic and inhuman behaviours we have thrust upon us by the ever increasing industrialised managerialism we are forced to work in.
What then, is professionalism in 2020?
In the public sector professions, it appears to me that it is a word more discussed than demonstrated in some quarters these days. Much is said, and written about it, courses are created for the development of it, lawyers defend it – and prosecutors lament the absence of it and yet who is really sure what it is?
Is professionalism something we have, or we are? Is it inborn, or do we develop it, learn it, over time? Does it come with a uniform, a white coat and stethoscope that announces one day, “I am professional?” And if so, does the professionalism evaporate when the clothing is removed? Now, in a world where professionalism seems to be defined by the paymaster rather than the professional body, I wonder.
So what did the word mean, originally?
Historically the professions served the people, and although not all professions today are state funded, providing a service is still a strong element. Traditionally, professionalism referred to the behaviours of those who had a considerable body of knowledge and understanding of a complex topic which had been years in the making, who had developed complicated and sophisticated skills and along with both of those was a practitioner who had not only acquired the skills and knowledge necessary to perform a role but who also embodied the personal attributes necessary to discharge their duty in a manner that best served the people who needed them. The depth of the passion of a professional, the level of acculturation and care over years, is written through us like words in a stick of seaside rock. We are what they do. It is not that we care; it is that we cannot not care. Our service is automatic. It is embedded in who we are. We cannot escape it even if we try.
In a restaurant with a doctor, she broke off speaking and rose a few inches off her seat when she saw a frail person vomiting. Suddenly everything in her world had tunnelled onto the needs of the other person who looked sick. Walking along the street with a police officer friend, I am forgotten again as he stiffens at the sight of a teenager pushing another teenager in a small group. I tut, but then they both know that should a child look upset, it is I who is forgetting them and zoning into the young person, alert to what is going on, wondering if I need to help.
A professional knows themselves and their role. They understand the impact they have on others and take that knowledge seriously, and with both respect and gratitude. They are reflexively aware, alert to all possibilities and employ their knowledge, skills, emotional intelligence and intuition in as best a way as they can to serve people, as individuals. It take years to become a professional because mastery of a profession takes time, energy, commitment and heart. It takes soul. It takes something from us to be able to give to others.
Modern interpretations of professionalism are however, quite different. A quick flick through social media suggests that female surgeons should not post pictures of themselves in bikinis while on holiday; Zoom calls and webinars should have neutral backgrounds, not washing hanging up or dirty dishes on view; doctors should not share any personal information about themselves with their patients and junior doctors should not complain when they don’t get the supervision they were promised. What definition of professionalism can be gleaned from this random collection of opinions?
Professionalism today seems to mean empty, blank, neutral. If it were a house it would have magnolia walls; a portrait would be just the outline of the head; a car would only have four wheels and a chassis. It seems that a professional in 2020 needs to have no distinguishing features of their own. They are a blank canvas upon which the government paymasters can write their own agendas. Maybe a professional is just a series of small square boxes on which targets and measurements can be ticked off. A professional is a box; light, so it can be moved around, empty so it has no baggage and made of plastic so it is malleable to suit all requirements.
I fear the meaning of professionalism is being carefully altered to control us, berate us, gag us and ensure that we are little more than robotic automata, programmed to maintain an illusion, prevented from doing the complex jobs we have trained so long to do. Just as we misuse the term emotional intelligence to mean those who know when to keep quiet for corporate benefit so I fear we are being managed into an alternative universe where professionalism does not mean what it has previously meant. My fear is that professionalism as a concept is being appropriated for subversive purposes. It is being rebranded not as a mark of professional autonomy binding highly educated, highly skilled practitioners together, and to their collective mission, but it is being used to dumb down choice, agency and individualised service, to make a one size fits all that is easier for the management world to count and control. I fear that professionalism today appears to demand that we hide our real selves from sight, keep our real thoughts to ourselves, and at all times, think, talk and behave in a way that is consistent with the corporate message and only when we get out of work can we let our passions loose.
A recent comment on twitter suggested that the concept of professionalism has been weaponised against medical students – it is a form of control and reinforcement of a minority opinion of value. In nursing too it was felt that aspects of personality and individuality were restricted under the guise of professionalism and that the concept was used to reinforce behavioural silence and restrict dissent. But what if that dissent is essential to the security of the service users and the professionals involved in their support? Still in the NHS in the UK, whistleblowing is treated as gross professional misconduct and many people who have tried to protect patients have been persecuted. What does that say about the professionalism of the organisations who set themselves up to defend professionals against such attacks? Yet again professionalism is seen as little more than conformity, compliance and conspiracy to silence.
This is so wrong.
We need to get back to the essence of the word. The professional self arises from a complex interplay of internal factors, such as personal values and external factors, such as social contexts and roles expectations. As professionals we are constantly involved in a dance of intimacy between the contexts in which we work, the people we serve and the personal values we bring to that work.
Professional identity constitutes and is constituted by personal identity. Separation of those two elements is nonsensical.
For what is a profession if it is not a passion? What use is service to humankind if it is not embedded with love, care, concern and strong feeling? How can we truly help and support others if all we do is read from a script and follow an algorithm?
By all means, 21st century, if you want me to be an automaton, repeating your mantras, aping your robots, then I can do that. But there will be no extra mile, so personalised service, no linking with others who may need to be involved. There will be no heart, no soul, no tears, no joy. Only mediocrity and monotony. If that’s what you want, then go ahead. Try it out. See where it leads. Kill the essence of the practices that have taken centuries to develop with your obsessive need to control. By the time you have realised your colossal mistake, there will be no one left working who remembers how to do it properly. What will we do then?
We need to resist the narrative that says professionalism is merely compliance, and stand up for our hard won expertise. We know that all professions are defined by their common beliefs and practices, and we can still work within those boundaried definitions, without being robotic duplicates of one another. What we do is governed by professional standards, education and training, behavioural norms and group think. But who we are is not up for negotiation. A professional without an opinion is not a professional.
Professional work is nuanced, complex, contradictory and highly individualised, tailored to the needs of each member of the public we serve. It needs practitioners who are similarly heterogeneous. Take away our uniqueness and you don’t have a professional.
Is that where we are heading? If so, pity help us all.