OPINION
1 University of Cardiff, Wales, UK
2 University of Glasgow, Scotland, UK
Cite this as: BMJ 2024;384:q424
http://dx.doi.org/10.1136/bmj.q424
Published: 27 February 2024
the bmj | BMJ 2024;384:q424 | doi: 10.1136/bmj.q424
Professionalism in 2024: today's doctors shouldn't be held to outdated
BMJ: first published as 10.1136/bmj.q424 on 27 February 2024. Downloaded from http://www.bmj.com/ on 21 March 2024 by guest. Protected by copyright.
ideas
Nicholas Phillips and Marina Politis question whether the concept of professionalism is always
representative of today's medical workforce
Nicholas Phillips, 1 Marina Politis2
Professionalism is a term that most healthcare doctor for wearing their natural hair in an “Afro Puff”
professionals are familiar with, but defining it can because this apparently looked “unprofessional” are
be challenging and often varies by context and all too common. The doctor subsequently suggested
person. In recent years, there’s been growing they should straighten their hair. This cannot be
awareness of how the concept of “professionalism” acceptable in UK medicine today.
can be exploited to maintain the status quo,
perpetuating a regressive norm of who a doctor Systemic misuse of professionalism
should be, rather than benchmarking the standards On a systemic level, professionalism can be misused
they should follow while practising medicine. These as a tool that props up racist or discriminatory beliefs.
biases can lead to the policing of people's Data show that Black and ethnic minority doctors are
individuality, harming the workforce, and more likely to be referred to the General Medical
entrenching inequalities and attainment gaps. Council and investigated.6 Given the racism that is
endemic in the NHS,7 the disproportionate number
When medical students or doctors are told to
of complaints and referrals experienced by ethnic
subscribe to certain norms under the pretext of
minority doctors could be a sign of how their
professionalism, or are accused of being
professionalism isn't given the same credit as their
unprofessional for deviating from someone else's
white colleagues. The day to day
cookie cutter ideal, it can feel like we're being held
de-professionalisation of certain identities can result
to ransom by outdated ideas of who a doctor is.
in these doctors being more likely to have their skills
A mask of prejudice and character questioned, complained about, and
investigated. High profile cases such as Manjula Arora
The expectation that medics should fit a narrow
and Hadiza Bawa-Garba forced the medical profession
professional mould can pressure them to change how
to reckon with the racism that can shape the
they present characteristics associated with their
regulation of doctors.8 As many commentators
sexuality, ethnicity, or gender—or else risk being
pointed out, if these cases involved white male
labelled unprofessional.
doctors, would they have been managed in the same
Medical student, Nikki Nabavi, for example, reported way?
receiving feedback from a senior colleague that she
In medical schools too, professionalism can be a
was “too girly.”1 The use of professionalism to
thinly veiled disguise to mask discrimination or
perpetrate sexism and misogyny in healthcare
efforts to silence students. A BMA report listed
environments even extends into examination settings.
shocking examples of healthcare students and
One medical student’s account of inappropriately
professionals who had been told by senior colleagues
receiving a “professionalism yellow card” during her
that their queer identity and gender expression was
OSCE for her outfit choice drew outrage on Twitter
unprofessional.9 We have also heard of students who,
(now X) and prompted other female medics to share
on attempting to raise concerns about senior
similar experiences.2 Other doctors have had
colleagues, have had their worries dismissed as their
expressions of their identity, such as tattoos or
inability to work well in a team or with varying
piercing, labelled as unprofessional.3
personalities. We must all learn to work with people
Beyond the UK, we have seen how clothing choices with different character traits, but we should not be
can be weaponised against doctors in cases such as taught that tolerating bullying or prejudice is a
#MedBikini, where researchers judged public social commendable sign of professionalism.
media posts of women wearing bikinis during time
The common thread in many of these examples is
off as “potentially unprofessional.”4 When a group
that individuals and institutions with power can
of male surgeons can decide what professionalism
misappropriate the concept of professionalism,
means for women, police them outside of their place
leading us to pose a wider question: who defines
of work, and this is published—the Journal of Vascular
professionalism? The lack of diversity among people
Surgery later issued a retraction—something has gone
in senior medical positions means that the
drastically wrong in the system.
gatekeepers of professionalism may model the ideal
Professionalism can also be used to attempt to on their own attributes and lack any incentive to
disguise what is overt racism, such as Black women’s change a status quo which has served them.
hair being more likely to be perceived as
unprofessional.5 Experiences we’ve heard of such as
a medical student being sent home by a white senior
1
 OPINION

A future for professionalism

Professionalism is not an inherently negative concept.

BMJ: first published as 10.1136/bmj.q424 on 27 February 2024. Downloaded from http://www.bmj.com/ on 21 March 2024 by guest. Protected by copyright.
Professionalism is vital in a number of scenarios, such as instilling
the importance of respecting colleagues and preserving patient
confidentiality. Maintaining public trust in our profession and
providing staff with healthy working environments is essential.
However, can we say with conviction that this is what
professionalism currently represents? Accounts of professionalism's
inappropriate weaponisation to dilute individuality and diversity
and conceal discriminatory beliefs suggest otherwise.
When professionalism becomes a vehicle for prejudice it should be
challenged and we must move towards a new conceptualisation of
what a professional doctor is and how they behave. As medical
students, we must band together and hold our institutions to
account, calling for reviewed definitions of professionalism that
are representative and inclusive of today's society.
Ultimately, it is only fair to expect our regulatory bodies and
institutions to embody the professionalism expected of us.

Competing interests: None declared.

Provenance and peer review: Not commissioned; not peer reviewed.

NP and MP are joint first authors of this article.

1 Nabavi N. Too girly to be a doctor? BMJ Opinion. 15 January 2021.

https://blogs.bmj.com/bmj/2021/01/15/nikki-nabavi-too-girly-to-be-a-doctor/
2 Womersley K, Hare H, Kelly S, et al. Trying to fit in: why #DressLikeADoctor doesn’t work. BMJ
Opinion. 1 October 2021. https://blogs.bmj.com/bmj/2021/10/01/trying-to-fit-in-why-
dresslikeadoctor-doesnt-work/
3 British Medical Association. Making an impression: when medicine meets art. 19 August 2022.
https://www.bma.org.uk/news-and-opinion/making-an-impression-when-medicine-meets-art
4 Hardouin S, Cheng TW, Mitchell EL, et al. RETRACTED: Prevalence of unprofessional social media
content among young vascular surgeons. J Vasc Surg 2020;72:P667-671,
doi: 10.1016/j.jvs.2019.10.069
5 The Crown Act. Hair discrimination research: Dove CROWN studies. https://www.thecrown-
act.com/research-studies
6 NHS England. Medical Workforce Race Equality Standard (MWRES). WRES indicators for the
medical workforce 2020. July 2021. https://www.england.nhs.uk/publication/medical-workforce-
race-equality-standard-2020-data-report/
7 Tonkin T. Racism an issue in NHS, finds survey. BMA News. 2 February 2022.
https://www.bma.org.uk/news-and-opinion/racism-an-issue-in-nhs-finds-survey
8 Mahase E. GMC referrals: Doctors express scepticism over letter of “reassurance.”BMJ 2022;379:.
doi: 10.1136/bmj.o2800.
9 British Medical Association. Sexual orientation and gender identity in the medical profession.
November 2022. https://www.bma.org.uk/media/6340/bma-sogi-report-2-nov-2022.pdf

2 the bmj | BMJ 2024;384:q424 | doi: 10.1136/bmj.q424