Reply from Author: Missing the Forest for the Trees

Abstract

We thank Dr Ong Siew Chey for his sincere comments. He opines that professional behaviour is a refl ection of an innate character trait, that behaviour is shaped early and is diffi cult to modify later, and that there are 3 ways of making doctors conform to professional norms. We would like to reframe the issue as this traditional view oversimplifi es and limits the appreciation of the complex problem of professionalism. Firstly, the pessimistic notion that ethical/moral behaviours are hard to change with increasing seniority is fortunately refuted by evidence. Advances in moral reasoning increase with age throughout a person’s lifespan, and this progression in adulthood is correlated with education. 1 Secondly, even though character traits do infl uence professional behaviour, these traits are but one of several factors infl uencing professionalism when we take a systems perspective. 2,3 Organisational culture is another component of the system infl uencing professional behaviours. 3 In psychology, the phenomenon of “moral elevation” describes how others are motivated to behave ethically when they see others doing likewise. 4 Regardless of a person’s traits, an institutional culture of ethical behaviour is another system component that can promote professional behaviour in both senior and junior doctors.