CURRENT CONCEPTS Ethics and Professionalism for Hand Surgeons Ghazi Rayan, MD, Steve Glickel, MD B EYOND THE PRECEPT of “first, do no harm,” our ethical code dictates that we place the welfare of those in our charge beyond all other concerns. Our commitment to professionalism ensures that we perform our duties in a mindful, respectful manner that takes into account both the physical and the psychoso- cial manifestations of disease. Paul Starr, in his classic book The Social Transformation of American Medi- cine, 1 defined the medical profession as “an occupation that regulates itself through systemic, required training and collegial discipline...and that has a service rather than profit orientation, enshrined in its code of ethics.” Put together, the realization of our dedication to ethics and professionalism leads to a commitment to lifelong learning and personal improvement, collegiality and advancement of the field, and a deep respect and admi- ration for the trust imparted to us by our patients. Adherence to professionalism is being promoted at many levels of medicine, including at the medical stu- dent and resident levels, as part of the competency- based educational objectives. Both the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education have identified profes- sionalism as one of the 6 core competencies, alongside medical knowledge and patient care, and the specialty boards have listed professionalism as one of 4 main competencies for Maintenance of Certification. Spe- cialty societies, including the American Society for Surgery of the Hand (ASSH), have created formal pol- icies and standing committees to promote ethical con- duct among their physicians and to address the concerns of their members and the public about the newly emerg- ing ethical challenges of practicing medicine today. Under the leadership of Dr. Steven Glickel, a formal code of ethics and professionalism and a standing ethics and professionalism committee were created by the ASSH within the past year. The role of the committee has been evolving, but currently, it serves primarily for consultation regarding breaches in the code and for education and promotion of our values to all ASSH members. Among our efforts, forthcoming articles in the Journal of Hand Surgery will discuss vital ethical and professional issues that are pertinent to hand sur- geons. We hope to improve the already excellent quality of care provided by hand surgeons worldwide by remind- ing us all of the great privilege that we have earned to care for the sick, and the great responsibility and com- mitment that are demanded by that privilege. Please take the time to read the code of ethics and profession- alism, and feel free to contact us with any suggestions or concerns. Code of Ethics and Professionalism 2 The following Code of Ethics and Professionalism has been adopted by the American Society for Surgery of the Hand (ASSH) and sets forth aspirational standards of conduct that define the essentials of honorable be- havior for its members. I. Relationship with patients. The Hand Surgery profession exists for the primary purpose of caring for the patient. The physician-patient relationship is the central focus of all ethical concerns. A Hand Surgeon should be dedi- cated to providing competent medical care with com- passion, diligence, and respect for the patient. The Hand Surgeon may determine whether to accept the care of a patient, but should not decline to accept a patient on the basis of race, color, religion, sex, age, national origin, or a disability. Having undertaken a patient’s care and having not been released from responsibility by the patient, the Hand Surgeon may discontinue services only after giving adequate notice so that the patient may obtain alternative care. The Hand Surgeon shall explain to the patient in understandable terms, the options for treatment, the reasons for the recommended course, and the risks and benefits associated with the recommended and alternative options. II. Decency and integrity. The Hand Surgeon should main- tain a reputation for decency, honesty, tolerance and truthfulness with patients and colleagues. The Hand Surgeon should not engage in any behavior that would From the Division of Hand Surgery, INTEGRIS Baptist Medical Center, Oklahoma City, OK; and C.V. Starr Hand Surgery Center, St. Luke’s-Roosevelt Hospital, New York, NY. Received for publication June 11, 2010; accepted June 19, 2010. No benefits in any form have been received or will be received related directly or indirectly to the subject of this article. Corresponding author: Ghazi M. Rayan, MD, Division of Hand Surgery, INTEGRIS Baptist Medical Center, 3366 NW Expressway, Oklahoma City, OK; e-mail: ouhsgmr@aol.com. 0363-5023/10/35A09-0033$36.00/0 doi:10.1016/j.jhsa.2010.06.022 Current Concepts 1554  ©  Published by Elsevier, Inc. on behalf of the ASSH.