Trust in Professional Integrity: trust

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Monday, March 3, 2014

The story of Dietitians for Professional Integrity

In 2012/13, a group popped up on Facebook and Twitter called Dietitians for professional integrity (DFPI). This is an American group of dietitians, who have opened themselves up internationally to document and discuss the real conflict of interest that exist between food corporations and nutrition/health advocacy organisations. At its core, DFPI is concerned about the credibility and sustainability of the profession of dietetics.

The formation of DFPI came on the back of the report “And now a word from our sponsors: are Americas nutrition professionals in the pocket of Big Food?” The report, released early in 2013, was specific to the relationship between food industry and the American dietitians’ professional association – the Academy of Nutrition and Dietetics (AND). At the time of the public report, the AND was called the American Dietetics Association (ADA).

When I first heard about DFPI, it seemed a bit ridiculous there would need to be a separate group with its principle platform being “professional integrity”. I mean, who wouldn’t be for professional integrity? Did this mean those who didn’t support the group had less integrity?

As I have looked further into what professional integrity means and what it looks like, there is good reason for the concerns tabled by DFPI; there is certainly more than enough compelling evidence to support their call to action.

The premise for DFPIs call to action is the ANDs protracted dependence on corporate money; despite strong evidence the influence corporate money has on the ability to achieve “health for all”.

My conclusion of what DFPI stand for is this:

“Accepting corporate money means the AND is no longer in the business of health, they are in the business of making money.”

I do not think DFPI believe members of, and those who work within the AND have no integrity (see DFPI’s FAQ). The use of the term “professional integrity” by DFPI is to encourage the AND to re-think its collective “professional integrity” in the context of the evidence on the influence of corporate monies on [any] organisation/s.

DFPI know professional integrity is worth fighting for. If dietitians want to be taken seriously in the world, subscribing and truly acting to professional integrity is expected. Not just expected but, rightly, assumed of a profession and the professional organisation that represents them. As is current, the AND profess to a) represent every dietitian across America, and b) be the trusted “go to” independent advocacy organisation operating in a civil society, these requests by DFPI are not only reasonable, but a minimum standard. If a) and b) is no longer what the AND is about, then this should be stated and the structure and function changed accordingly. We must not ignore the real-life evidence documented from the experience of our medical colleagues.[1]^[2]
[3]

Meanwhile, in Australia, the formation of DFPI was exciting, real, and tangible. Brave too. Finally there was a simple and open dialogue that was inclusive and fast moving. Thanks social media! DFPI even caught the eye of the Australian My Health Career job search group ran a feature on DFPI opening with:

While My Health Career usually focuses on stories about health professions in Australia, we couldn’t help but raise awareness about a controversial issue that is causing a bit of a stir in the US at the moment. From what we hear, things similar to this happen to a much lesser extent in Australia. 04-05-2013

I note the soft comparison with Australia; the suggestion DFPI may not be needed here. Sure, there are differences between Australian dietitians and their own professional association. However, it is in fact because of these differences there is a strong case for an Australian arm of DFPI…..but that, my friends, is another story.

Second-year medical students define "ethics"

This post is an adjunct to the Trust in Professional Integrity series. It supports particularly the 2nd of the four posts where I *ahem* define professional integrity. I do have these "definitions of ethics" publicly available in the "library" of my PhD website. I post them there for the students to access, to see the final product of their class discussions.

I share with you these definition of "ethics" by second year Monash medical students (2013). These definitions come from students who have had four two-hour facilitated tutorials (me as the facilitator) on "ethics". In the final of the four sessions, I ask the students to write down their definition of "ethics". I do this at the beginning of the four sessions too, but this early set of definitions is used to facilitate discussion over the four sessions.

Because of the way we assess students, by exam mostly, the recall of learned knowledge, I felt obliged to have students practice "writing". They have only two or three minutes in class to summarise hours of discussion into no more than two sentences (given a short answer question on "ethics" is worth two marks). Like me, I think any reader will be impressed with what the students have come up with here. Do I have a favourite definition? You tell me your favourite, then i'll tell you mine ;)

@MDPStudy

What is ethics?

Ethics is a concept that involves considering the most humanitarian or caring method of acting. In medicine, it involves ensuring that decisions are influenced by what is best for the patient.

Ethics is about an awareness that your perspective of a situation is coloured by your experiences, attitudes and beliefs. Thus, it emphasises the importance in analysing your decisions and empathising with the ideas of others in the same situation even if they differ.

Ethics is the decisions made on a daily basis and the values, beliefs and morals that drove these decisions. It relates to empathising with others and should drive these choices also.

Ethics is the framework around which all of our decisions, both everyday decisions and medical ones are based. It relies on each of our morals, values and principles to form calculated decisions about what we believe to be right.

Ethics is an understanding of the different perspectives and situations that people live and work in, and the application of this to our decisions and world views.

Ethics is about understanding that different people have various interpretations of the same thing and putting that into practice. It is about appreciating and respecting people’s preferences and choices about their lifestyle and health.

Ethics is having empathy for others while putting yourself in others shoes.

Ethics are the moral principles that govern everyday life. They comprise the personal principles that an individual lives by and makes their decisions by. Ethics are influenced by the environment a person lives in as well as the people they meet and other ethical frameworks they encounter.

Conducting yourself in a manner that benefits the patient, does not harm the patient and in the best interests of the patient.

Autonomy
Beneficence
Justice
No harm

Ethics is the consideration of the many interconnecting values that underlie every human thought, action and decision. These values stem from basic moral principles that, although subjective, are shared by most individuals.

In relation to medicine it is how much information must be disclosed by the medical practitioner in order to be completely transparent with the patients so they can make an informed, autonomous decision.

Ethics is the process of applying empathy in decision making processes.

Ethics is a concept describing how we go about making decisions by taking into account the circumstances of other individuals and following our own set of moral codes.

An individuals morals and values as influenced by their environment, culture, religion etc. Ethics refers to an individuals integrity and moral compass.

To perform humanely even if it is not bounded by law. Justice, fair, transparent. To find a collegial solution (not simply a decision). Outcome for greater good. Recognise our values/bias on interpretation and judgement.

Ethics in a set of moral principles that guide us in relation to decisions that are…..

Being aware of ones own values and bias and others and making objective judgements about it is in our behaviour and decisions. Core values – autonomy, beneficence, non-maleficence, justice.

Framework of morals that guides behaviour and decisions.

A set of morals, principles, beliefs, and ideas which aid in guiding out actions be it good or bad.

Ethics is the culmination of ones rules and moral ideals.

Set of guidelines to guide society towards certain moral values.

A personal interpretation on and application of legal and moral issues based on personal knowledge, experience and culture.

Ethics is about fulfilling responsibilities in a personal sense as a member of society and in a professional sense as the provider of a service.

Ethics is being aware of ones self-bias. It is about following a moral compass to guide you to the more appropriate course of action in a given circumstance.

Ethics is a tool used to guide our choices and decision-making. Whereas law distinguishes between legal and illegal actions, ethics provides models which allow us to critique our thinking and better understand accepted codes of conduct within society.

Ethics is the moral compass an individual bases his/her choices on. This moral compass has been shaped by an individuals distinct/unique experiences, culture, up-brining and beliefs.

@MDPStudy
Other blogs by me

Evidence-based confessions of a dietitian

Dietitians: as effective as the evidence from clinical trials

Evidence small health changes are good

[Other stuff]

Friday, February 28, 2014

March is [unofficially] professional integrity month

Unofficial because it is possible the world is “awareness day/week/monthed” out. I do not imply awareness campaigns are not important; we know some have made an incredible impact on the way humans operate in the world. So why would I not want to brand something as important as professional integrity in the public domain? Because, ironically, professional integrity is about trust in our fellow humans’ desire to have professional integrity. Therefore, it would seem patronising to insist one subscribes to a month of “professional integrity” activities, when one must trust that we all act with integrity. It would be akin to announcing a month dedicated to reminding humans what it is to be human. Ok, when I put it that way it does seem the world may benefit – but calling it officially is saying “humans lack integrity and are unaware that they lack integrity” which I do not believe is definitively true.

A “professional integrity month” may come with collateral damage: any group or individual who didn’t participate, for example, do they have less integrity? Conversely, for the people who do participate, are they so lacking in professional integrity they participate to get some? And do those who participate automatically get to feel they have more integrity than others?

This is sounding a bit cryptic. The key point is professional integrity is in many ways subjective: a persons “integrity compass” is shaped by their experience in the world. One’s “integrity” is their truth, and their perception, analysis, interpretation and translation of that truth (based on their own life experiences).

The reason I am naming March “professional integrity month” is because I have been exploring what professional integrity means, and I want to share what I have found. And really, “professional integrity month” simply means I will post one of the four articles each Monday in March; I work better under pressure and with clear deadlines. However, the impetus for me to investigate, and write about professional integrity was the appearance of the American group “Dietitians for Professional Integrity (DFPI)”. And it is with DFPI this four-part series begins.

The first article is DFPI’s story; what DFPI mean by professional integrity in the context of being a health profession and the public perception of the profession. The second article deals directly with professional integrity. Wait. Lower your expectations here. My “deal with” is not a checklist of behaviours….professional integrity, for the reasons in the opening paragraph here, is rather challenging to put into words that mean something for our day to day activities. But I’ve given it a red hot go. The third article is my own disclosure of interest. Disclosure of interest and conflict of interest is presented as part of professional integrity in article two; you will see across articles two and three the inherent difficulties in being absolute with “professional integrity”. The fourth and final of the series compares and contrasts DFPI with Australian dietitians offered as a starting point to discuss the need for an Australian arm of DFPI.

Enjoy. @MDPStudy

Other blogs by me

Evidence-based confessions of a dietitian

Dietitians: as effective as the evidence from clinical trials

Evidence small health changes are good

[Other stuff]