Volume 8, Issue 5 - May 2025

Dear Yvonne,

In editing this issue of The Academy, 

I was struck by the breadth of topics that touch on professionalism and all that healthcare professionals must consider in their practice as they endeavor to care for patients. This issue takes up this breadth in two ways; first, by considering three distinct topics that impact patient-centered healthcare professionalism and, second, by engaging three different genres of writing: a statement, a response, and a book review.

Our first article, “An APHC Statement on Diversity, Equity, Inclusion and Belonging,” is a statement by the Board of the Academy for Professionalism in Health Care on the current status of diversity, equity, inclusion, and belonging considerations in healthcare. The statement, supported by the Board and chiefly authored by Dr. Dennis Novack, connects concerns about recent departures from respect for diversity, and related concepts, in healthcare by leading political officials in the United States. The statement is a powerful perspective rooted in the obligations of healthcare professionals to provide, where possible, optimal patient care. The statement is an excellent example of the importance of looking beyond merely the patient in front of a clinician in order to care best for that very patient; attending to other factors which influence patient care and outcomes is a crucial aspect of realizing professionalism in healthcare.

The second article is a response to Jill Thistlethwaite’s piece on whistleblowing from our last issue. In “For Whom (and Why) the Whistle Blows,” Tom Koch engages Thistlethwaite’s work through the lenses of ethics and professionalism. Koch touches on modern ethical considerations, the public’s good, and the role of civil society in his reflections. Of special note is the historical framing he brings to the discussion, tracing professional concerns back to Hippocrates and highlighting the primary duties of physicians, first to the health of patients and then to all members of society.

The final article is a review of the recent book on artificial intelligence and healthcare by Charles Binkley and Tyler Loftus. In “Centering the Patient in AI Ethics: A Review of Encoding Bioethics,” I take the editor’s prerogative and share thoughts on a new book: Encoding Bioethics: AI in Clinical Decision-Making (University of California Press, 2024). That text opens with the admission that as surgeons both authors, though they inhabit a number of professional roles, see, “Providing the best patient care possible…” as their “…true north and deep passion” (xi). Though a great deal has been written, especially of late, on the role of artificial intelligence in healthcare, this book will be of special interest to The Academy’s audience given its deep engagement with professionalism and ethics.

It is my hope that the reader will find each article useful and that together they might help to highlight the expansive influences on healthcare professionalism. In addition to these three articles, the reader will find information about opportunities relevant to those with interests in professionalism, as well as upcoming APHC and other events. Of special note is the upcoming conference, which takes place in early June and can be attended both in person and virtually.

Bryan Pilkington, PhD is Editor-in-Chief of The Academy: A Forum for Conversations about Health Care Professionalism

1. APHC Hybrid Conference - Building and Rebuilding Trust | June 4-6, 2025

2. An APHC Statement on Diversity, Equity, Inclusion and Belonging 
3. For Whom (and Why) the Whistle Blows
4. Centering the Patient in AI Ethics: A Review of Encoding Bioethics
5. 37th Annual Summer Seminar in Healthcare Ethics
6. Healthcare Professionalism: Education, Research & Resources Podcast
7. APHC Member Benefits

Last Week to Register

Don't miss your chance to join the Academy for Professionalism in Health Care's International Hybrid Conference—a dynamic gathering of professionals and trainees committed to advancing professionalism across all health-related fields.

This inclusive, global event will be held in person at Rosalind Franklin University of Science and Medicine (North Chicago, Illinois, USA) and virtually via Zoom.

🗓️ Conference Highlights Include:

• 3 Keynote Presentations

• 3 Symposia

• 1 Fireside Chat

• 15 How-to Workshops

• 3 Problem-Solving Sessions

• 6 Panels

• 28 Oral Presentations

• 8 Flash Presentations

All sessions are hybrid and will be recorded for on-demand viewing.

There will be ample opportunities to network with colleagues. Over 60 sessions will cover topics such as:

• Rebuilding Trust after Professionalism Lapses (Pre-conference Workshop)
• Theoretical Concepts & Frameworks
• Patient Trust – Difficult to Gain, Easy to Lose
• Trust Threats in Multicultural Learning Environments
• Entrustable Professional Activities (EPAs)
• Trust Building within Interprofessional Teams
• Trust in Research & Processes of Protection (e.g., IRB)
• How Trustworthy is Technology (e.g., AI)

📢 This is your last opportunity to register—secure your spot today! Click HERE to register.

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The Academy for Professionalism in Health Care (APHC) believes that diversity, equity, inclusion and belonging (DEIB) are core tenets of healthcare professionalism. DEIB concepts guide us to create a workplace and care environment where everyone feels valued and respected. DEIB educational goals are to promote understanding, empathy, and compassion for all those who seek care.

In a recent letter addressed to all educational institutions that receive federal funds, the Department of Education threatened to withdraw funding for all activities related to diversity, equity and inclusion, stating that “Educational institutions have toxically indoctrinated students with the false premise that the United States is built upon ‘systemic and structural racism…’”

Structural racism exists, created over centuries by false beliefs about people of color. These beliefs engendered innumerable laws and social policies that led to vast disparities in wealth, education, health and healthcare and needless suffering and death. ^1,2 As health care professionals we cannot ignore the realities of structural racism. We cannot let stereotypes and biases transmitted through generations affect our care. We must create respectful learning climates for all learners that are free from biases and help them manage microaggressions and identity-based insults from patients and others on health care teams. ^3-5

With the growing diversity of the US population⁶, an equity and inclusion lens is becoming more critical to healthcare education and practice. Diverse health care teams lead to better care. ⁷ People of color trust that their health care providers understand them better if they are the same ethnicity or skin color. ^8,9 Healthcare professionals from underrepresented backgrounds are more likely to practice in underserved communities, increasing access to care for those who need it most. ¹⁰ There are positive associations among diversity, quality and financial performance in healthcare. ¹⁰

The promotion of DEIB in health care applies to and enhances optimal delivery of care for all people. We as health care professionals pledge not to discriminate against any individual because of age, ethnicity, skin color, sexual orientation or gender identity, disability, religion or socioeconomic status. We are committed to the primacy of patient welfare, patient autonomy, and to social justice. We strive to work actively to ensure a just distribution of resources, to advocate for the elimination of health disparities, and to eliminate discrimination in health care. All who seek our care deserve our respect, understanding and compassion.

Health care at its core is a moral endeavor ¹¹, based on values such as respect, acceptance, humility, altruism, and compassion.  Health care professionalism is based on ethical principles of beneficence, doing no harm, respecting autonomy and ensuring equitable treatment for all. As a society that promotes professionalism in health care, the Academy for Professionalism in Health Care recognizes that promoting DEIB is an expression of our core values and ethical commitments. ¹² 

1. Anyane-Yeboa A, Sato T, Sakuraba A. Racial disparities in COVID-19 deaths reveal harsh truths about structural inequality in America. J Intern Med. Oct 2020;288(4):479-480. doi:10.1111/joim.13117
2. Bailey ZD, Krieger N, Agenor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. Apr 8 2017;389(10077):1453-1463. doi:10.1016/S0140-6736(17)30569-X
3. Anderson N, Lett E, Asabor EN, et al. The Association of Microaggressions with Depressive Symptoms and Institutional Satisfaction Among a National Cohort of Medical Students. J Gen Intern Med. Feb 2022;37(2):298-307. doi:10.1007/s11606-021-06786-6
4. Karnaze MM, Rajagopalan RM, Eyler LT, Bloss CS. Compassion as a tool for allyship and anti-racism. Front Psychol. 2023;14:1143384. doi:10.3389/fpsyg.2023.1143384
5. Sue DW, Alsaidi S, Awad MN, Glaeser E, Calle CZ, Mendez N. Disarming racial microaggressions: Microintervention strategies for targets, White allies, and bystanders. Am Psychol. Jan 2019;74(1):128-142. doi:10.1037/amp0000296
6. Bureau UC. 2020 U.S. Population More Racially and Ethnically Diverse Than Measured in 2010. https://www.census.gov/library/stories/2021/08/2020-united-states-population-more-racially-ethnically-diverse-than-2010.html
7. Gomez LE, Bernet P. Diversity improves performance and outcomes. J Natl Med Assoc. Aug 2019;111(4):383-392. doi:10.1016/j.jnma.2019.01.006
8. Alsan M, Garrick O, Graziani G. Does Diversity Matter for Health? Experimental Evidence from Oakland. American Economic Review. 2019;109:4071–4111.
9. Shen MJ, Peterson EB, Costas-Muniz R, et al. The Effects of Race and Racial Concordance on Patient-Physician Communication: A Systematic Review of the Literature. J Racial Ethn Health Disparities. Feb 2018;5(1):117-140. doi:10.1007/s40615-017-0350-4
10. Hamed S, Bradby H, Ahlberg BM, Thapar-Bjorkert S. Racism in healthcare: a scoping review. BMC Public Health. May 16 2022;22(1):988. doi:10.1186/s12889-022-13122-y
11. Berwick DM. The Moral Determinants of Health. JAMA. Jul 21 2020;324(3):225-226. doi:10.1001/jama.2020.11129
12. More details and references can be found in Novack DH., Burnett, C. (eds) Antiracism in Healthcare. https://webcampus.med.drexel.edu/PCHC/

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Whistleblowing carries the taint of disloyalty whoever the whistleblower may be. No matter how worthy the intent or how important the revelation those who reveal what others thought should stay hidden are forever deemed untrustworthy (Thistlethwaite 2025). They have somehow violated the community of “professionals” to which they belonged.

The best known whistleblowers are referees who stand alongside a game’s players and whose whistles call out offences. Individual judgments may be questioned but not the referee’s role. Their loyalties are not to a specific team or individual player, after all, but to the integrity of the game, to fairness on the diamond, field, or pitch. Without them, the match would be chaos ending in a brawl.

Historically, Hippocratic practitioner’s primary duties were first to the health of a patient and then to all citizens in the shared society. Greeks “did not distinguish between their own interests and the interests of the community in which they lived” (Singer 1983, 20). The Hippocratic vow to ‘keep the ill from injustice’ and the historical definition of the physician as a moral agent (Englehardt 2003, 100) created a set of community members whose duty to the wellbeing of patients and the community at large were inextricably entwined (Koch 2012, 34-35).

A civil society requires a guardianship that can balance and off-set the priorities of the market place and officialdom (Jacobs 1992). As first mercantilism and then industrialism transformed American economics and society, creating ever more unequal societies, that role fell to the practitioner. Eighteenth century physician Benjamin Rush, for example, a signatory of the U.S. Declaration of Independence, diagnosed poverty as a primary, disease-inducing ill requiring official redress. What was the point of caring for patients, his contemporary Dr. Samuel Latham asked, if the poor were saved only to conditions inimical to health and guaranteed to breed other fatal diseases? Practically, poor drainage, poor sanitation and poor housing were ills physicians identified that requiring redress (Koch 2012, 35).

Nineteenth century practitioners in England, France, Germany, and elsewhere called for officialdom’s redress of industrialism’s evolving ills.  “As well as being a precondition of liberty, health was also the readiest yardstick of injustice, and the most unanswerable justification for social change” (Hamlin 1998, 69). It was from this perspective that physicians decried poor sanitation, housing, and working conditions in their countries. Medicine is a social science, Rudolph Virchow famously declared, “and politics is nothing more than medicine on a large scale.” From that perspective the Hippocratic practitioner was the vocal referee, the advocate and activist guardian in the moral economy of society.

Ethics today

Beginning in the 1980s, the bottom-up, Hippocratic ethic of relational care and duty was replaced by a top-down Bioethics embracing the neoliberal economies and priorities of the Regan-Thatcher era. In this new alignment “the market was treated as a moral, not just an efficiency value … little interested in the common good” (Callahan 2012, 132-133). The practitioner’s role as guardian cum referee focusing on the common good was disparaged and devalued (Veatch 2012). And so, “it also became clear that the field was not going to be dedicated to whistle-blowing--bioethics has not turned out many Ralph Naders (Callahan 1993). If as Robert Veatch insisted, the physician had no more moral standing than the average shoe salesperson how could it be otherwise?

Practitioners who today publicly advocate for a patient’s and for the public’s good implicitly violate a concept of professionalism as the unwritten and never negotiated contract between medicine, government, and business (Cruess and Cruess 2000). With it practitioners were devalued as guardians, referees standing apart, but players integrated into business and government and thus beholden to their priorities. For them to criticize policies or systems is to be …offside.

Still, some persist. Toronto physician Nancy Olivieri was criticized by her hospital and a drug company (that threated legal action) after she violated a research contract by publicly reporting adverse effects of a drug she had been contracted to test. In what became a cause celebré, she responded that as a physician her duty was first to those in her care and then to the greater community (Shuchman 2005). In much the same vein, Cleveland State University bioethics professor Dr. Mary Ellen Waithe was criticized when she brought to a local prosecutor’s attention the ethics and legality of drugs administered at the Cleveland Clinic to hastened the deaths of severely ill, potential organ donors (Agich 1999). Hospital ethicists said her going   public was not “collegial” she replied that a citizen seeing wrong has a duty to go to the law (Koch 2002, 152-3).  Her primary responsibility was not to the University, the hospital, or its transplant program but as a citizen, ethicist, and teacher.

Conclusion

Hippocratic practitioners stand a step outside society so they can comment as guardians on and thus best serve the greater public.   Forget whistleblowers. The very language does damage, setting the stage for reflexive distrust. Think guardianship with practitioners as referees whose allegiance is to the game rather than a specific player, team, or league.

Ask not for whom the whistle blows. It blows for you, and me.

Tom Koch is a medical ethicist, geographer and historian at the University of British Columbia. His most recent books are Seeking Medicine’s Moral Centre: Ethics, Bioethics, and Assistance in Dying and Ethics in Everyday Places: Mapping Moral Stress, Distress, and Injury.

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In their recent book, Encoding Bioethics: AI in Clinical Decision-Making (University of California Press, 2024), Drs. Charles Binkley and Tyler Loftus do more than simply add to the ever-growing literature on AI in healthcare. It is shocking to think that so much of what has been written about AI in the last few years is, or very soon will be, out of date, but not Encoding Bioethics. This text holds up and promises the staying power to make it worth the purchase.

Six chapters comprise Encoding Bioethics. The first chapter introduces the reader to the subject matter: ethical considerations of artificial intelligence clinical decision support (AI CDS) and the final chapter offers clear take home points on how to incorporate ethics in AI CDS at each step of a system’s life cycle. The four middle chapters, which contain the heart of the book’s argument, each center on a particular perspective relative to AI CDS: the physician, the patient, the developer, and the health system executive. For a book that engages sophisticated content in the AI, clinical, ethical, and management spaces, it is extremely accessible. Binkley and Loftus write in a clear and careful manner, appending each chapter with an illustrative set of cases of interest and thought-provoking questions. Both the clarity of writing and the manner in which the text frames considerations relative to AI CDSS in healthcare demonstrates why the text will be relevant for those who find themselves in any (or a few) of the groups of stakeholders that they address, and for quite some time.

The main argument of the book begins with a focus on the relationship between physicians and patients with a clear relevance for considerations of professions and professionalism in healthcare. It is from an understanding of that relationship as foundational that Binkley and Loftus build an ethic for AI CDS. This perspective inflects how, not only physicians, but others involved in healthcare must interact ethically with AI CDS. They write, “we endeavor to unite perspectives from major stakeholders of ethical AI in clinical decision-making…to generate a shared understanding of the values and principles of each stakeholder” (xii). Though stakeholder perspectives are treated well and charitably, it is clear that it is the perspective of the physician that is crucial, though not central, in this text. It is what physicians, and derivatively others, owe to patients that informs the ethic and mandates a deference to the patient-centered practice of healthcare.

In looking to bring a wide array of clinical professionals, nonclinical professionals, and others into the fold, Encoding Bioethics realizes its authors’ aims of “creating a common understanding of ethical values between clinicians and nonclinicians in caring for patients” (xiii) and does so in interesting ways. For example, the authors go beyond the usual requests of developers, that they build algorithms to satisfy the bare minimum of ethical standards. Binkley and Loftus argue that there exist “unique opportunities… to generate algorithms that aid stakeholders in making ethical decisions by accurately representing the complex, nonlinear associations among bioethics principles and patient specific factors…then learning to identify bespoke, ethically sound solutions” (102). On this framework developers would, thus, not merely build made-to-order products, but be involved in creating something that deeply engaged ethics and professionalism principles. Though the book comes from two physicians – two surgeons, in fact – they take all identified stakeholders seriously and offer ethically and professionally rich charges to each (e.g., they highlight the importance of epistemological modesty for health system executives) and include in their oversight recommendations: patients, families, community members, five distinct sets of clinicians, four different representatives of the technology space, legal experts, quality and patient safety advocates, bioethicists, representatives from diversity, equity, and inclusion, patient experience personnel, and the list goes on.

A reasonable review, even of an excellent book, requires a critique of the text: objections, problems, questions to be considered, et cetera. Were readers to quibble with the arguments of Encoding Bioethics, those quibbles would most likely be directed at the foundational focus on physicians and their patients. First, there are some for whom the argument will be a nonstarter. Though that group is likely to be small, if the physician-patient relationship is not where one begins one’s ethical and professional theorizing in healthcare about emerging technologies, then this book might not be of interest. One might prioritize other considerations, taking up a population health or a systems focus, and argue that other health-related considerations are paramount, not what is owed to patients by physicians. Though medicine might direct its efforts toward patients, which Binkley and Loftus remind us comes from the Latin word for suffering (56), there may be good reasons to focus on (whole) persons or members of communities (full stop), not only those in sickened states, and build an ethic not rooted in medicine’s foundational relationship. Second, there are some who would root the ethical analysis of AI CDSS from a tech ethics perspective, not accepting the claim that ethics is, at its core, relational. Third, there are some who would prioritize an AI ethic rooted in another profession – say, nursing – accepting the relationality of ethics but privileging another health profession. Though Binkley and Loftus are deeply inclusive in their approach, focusing on the aforementioned shared conversation, they do believe that physicians have “distinct ethical obligations,” that “most nonphysician providers perform their duties under the sponsorship of a physician,” and that “decisions for which AI systems will offer support will be made primarily by physicians” (179). As they write early in the text, what unifies the diverse stakeholders – regardless of their distinct perspectives and values systems – is that they “all have a common relationship to AI CDS: entering into the physician-patient relationship” (7).

Overall, Encoding Bioethics, is a well-written, thoughtful, and ethically rich book. It offers a strong, inclusive argument for an ethical and professional approach to AI in healthcare, as well as practical framework for the role of AI in clinical decision-making. The book repays rereading and will surely remain a “go to” text for physicians, patients, developers, and healthcare administrators, as well as ethicists and professionalism scholars, interested in decision-making in healthcare.

Bryan Pilkington, PhD is Professor of Bioethics in the Department of Medical Sciences at the Hackensack Meridian School of Medicine.

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37th Annual Summer Seminar in Healthcare Ethics
Live Online | August 4-7th, 2025 | 8am–2pm PT
Registration: $500 (early bird discount 20% off until May 15!)

We invite you to attend this engaging and interactive 3.5-day seminar hosted by the University of Washington Department of Bioethics & Humanities. Designed for clinicians, ethics consultants, and healthcare professionals, the course provides a practical introduction to clinical ethics using the widely respected four-box method.

Participants will explore real-world ethical issues in healthcare, build skills in case analysis and ethical decision-making, and engage in multidisciplinary small-group discussions. The seminar also supports preparation for the healthcare ethics consultation certification exam.

Course Text: Clinical Ethics, 9th Edition (or earlier editions)

More Info & Registration: 2025 Summer Seminar in Healthcare Ethics

Please feel free to share with colleagues—hope to see you there!

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Professional Formation and APHC collaborate on a podcast, Healthcare Professionalism: Education, Research & Resources.

Over 125 podcast episodes have been released with over 17,000 downloads.

Released every other Saturday morning, recent episodes include Rachel Pittmann discussing Telehealth Etiquette and Amal Khidir talking about Designing the Faculty Development Professionalism Program with Multi-cultural Perspectives.

You can access the podcast episodes on your favorite platform or at: https://bit.ly/PF-APHC-Podcast

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As a member, you have access to special benefits that include:

• Belonging to a community of like-minded professionals
• Participating in the monthly Professionalism Education
  Roundtables with authors, faculty, and researchers, plus accessing past recordings
• Accessing 15 Professional Formation modules for individuals for free
• Enrolling in the APHC Faculty Development Certificate program known as LEEP (Leadership Excellence in Educating for Professionalism), which was launched in 2020 and offers longitudinal mentoring for a select group of
  individuals seeking to deepen their knowledge and skills in
  professionalism education, assessment, and research
• Posting your research, articles, podcasts, webinars, conferences, and books in the newsletter distributed to about 15,000 people
• Receiving a 20% discount on educational videos created by the Medical Professionalism Project, which also allows you to obtain MOC and CME
• Registering for APHC conferences with discounts
• Participating in APHC committees, which include the conference program, membership, and education committees

Our annual membership fees are very inexpensive and are valid for one year from the payment date. Select from seven types of membership, including the institutional membership for four people. See the descriptions.

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Editor-in-Chief: Bryan Pilkington | Managing Editor: Yvonne Kriss

Please contact Yvonne if you'd like to contribute an article to this newsletter.

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