‘Professionalism’ is first step beyond the ABCs of preventive cardiology
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LOUISVILLE, Ky. — Look beyond the ABCs, toward diversity, respect and health equity, to improve prevention cardiology for the future, a speaker said at the American Society for Preventive Cardiology Congress on CVD Prevention.
Pamela S. Douglas, MD, MACC, FASE, FAHA, Ursula Geller Professor of Research in Cardiovascular Diseases at Duke University, past president of the American College of Cardiology and past president of the American Society of Echocardiography, was honored as the 2022 recipient of the Honorary Fellow of the ASPC Award and presented the keynote speech, “Strengthening CV Prevention for the Future: Beyond the ABCs.”
During the presentation, Douglas stated that beyond the scope of the ABCs of prevention, other factors contribute to population health and clinical practice: diversity with respect to people and perspective; respect in the form of climate, culture, well-being and inclusion; and heath equity in the form of social justice.
Douglas said diversity, respect and health equity represent the three dimensions of medical professionalism.
“Awareness of professionalism and appreciation of its central importance to both clinician well-being and patient safety is the first step,” Douglas told Healio. “This should be followed closely by efforts of organizations to set policies in this area, provide education to leaders and individuals and establish systems and structures to support professionalism. And of course, we each have our own part to play as we interact with each other and our patients.”
Douglas cited a recent report of the ACC Solution Set Oversight Committee published in the Journal of the American College of Cardiology, in which Douglas and colleagues issued a health policy statement that outlined a “General Approach to Building Respect, Civility and Inclusion,” as well as “Specific Programs Addressing Bias, Discrimination, Bullying and Harassment.”
The document made the following recommendations to eliminate bias, discrimination, bullying and harassment:
- establishment of confidential and fair mechanisms for reporting and investigating such instances;
- addition of institutional education, tools and implicit bias training to ensure unbiased hiring practices;
- adoption of metrics to track progress and inform future decisions;
- adoption of independent evaluation of culture and the effectiveness of efforts to reduce bias, discrimination, bullying and harassment; and
- recognition of leaders who promote and model excellence in these areas.
“In addition to recent ACC Health Policy statement on Respect, ACC and [the American Heart Association] recently published a consensus conference proceedings on professionalism. Both are great reading,” Douglas told Healio.
In 2021, the AHA and ACC published a consensus conference report in Circulation and the Journal of the American College of Cardiology addressing medical ethics, professionalism and other timely topics in CV medicine.
As Healio previously reported, the report is based on the previous joint 2020 consensus conference report and focuses on topics such as diversity, equity, inclusion and belonging; racial, ethnic and gender inequities; conflicts of interest; clinician well-being; data privacy; social justice; and modern health care delivery systems.
“It is hard to pick among the many important facets, but perhaps health equity/social determinants of health have the greatest impact on patient health,” Douglas told Healio. “In what dimension(s) of professionalism is improvement needed most urgently? I would pick health equity/social determinants of health as social and economic factors account for a greater proportion of public health than any other factor, including health behaviors and clinical care.”
To this point, Douglas cited the 1999 document published in the Annals of the New York Academy of Sciences, “Public Policy Frameworks for Improving Population Health.”
In this document, the authors stated that four conceptual frameworks could provide basis for developing public policy strategies to improve public health within wealthy nations: Determinants of population health; complex systems; an intervention framework for population health improvement; and public policy development process.
Douglas concluded by citing pearls from the American Medical Association Steps Forward for Health Equity:
- develop a better and shared understanding of racism and anti-racism and health equity;
- identify two or three equity-related measures meaningful to yourself, your health system and community;
- adopt measures to reduce inequities in access, quality of care and health-related social needs; and
- use real data to analyze care delivery and practice performance to identify disparities.
“There is no special significance [of professionalism] in preventive cardiology — any more so than in the rest of the field. The issues I am talking about tonight — diversity, respect and equity — are all important in all areas of cardiology,” Douglas told Healio.
References:
- AMA Center for Health Equity. www.ama-assn.org/about/ama-center-health-equity. Accessed July 29, 2022.
- Benjamin IJ, et al. Circulation. 2021;doi:10.1161/CIR.0000000000000963.
- Douglas PM, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2022.03.006.
- Tarlov AR, et al. Ann N Y Acad Sci. 1999;doi: 10.1111/j.1749-6632.1999.tb08123.
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Douglas PS. Strengthening CV Prevention for the Future: Beyond the ABCs. Presented at: American Society for Preventive Cardiology Congress on CVD Prevention; July 29-31, 2022; Louisville, Kentucky.
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