Physician Reported Challenges to Medical Professionalism: A Qualitative Study of Clinicians From Northern China

Background: Despite efforts to promote professionalism among physicians, many studies have confirmed the ongoing prevalence of unprofessional behaviours in medicine and alluded to the challenges to professionalism that physicians may encounter. Physicians may regularly witness unprofessional events and may even participate in unprofessional practices. Therefore, the current study aims to identify common challenges to professionalism and physicians’ priorities when coping with such challenges，in hopes of shedding light on the East Asian environment with respect to physician professionalism. Methods: Five focus groups were conducted with a total of 49 clinical physicians from two tertiary hospitals in Shenyang, the largest city in northern China. Socio-demographic data were obtained through a brief questionnaire, and participants were de-identified after being linked to verbal data from the focus groups. Focus group interviews were audio-recorded and later transcribed and subjected to an inductive thematic analysis. Results: A content analysis of the focus groups demonstrated that common professionalism challenges could be classified into five categories, namely: patients and their families (38%), society (22%), peers or teams (21%), institutions (13%), and education (n = 6%). Physicians failed to find current remediation measures, such as, discussing with supervisors, or reporting challenges to hospital or health authorities very effective. Conclusions: The current study suggests that challenges from patients and their families contributed the most to professionalism challenges in the hospitals in northern China. In terms of the systematic reform of medical education and the healthcare delivery system, health authorities and hospital administrators should aim at addressing challenges to physician professionalism by building up a protective atmosphere.