Professional Gatekeeping as a Function of Role Fidelity

Regardless of the level of practice, the ability and opportunity to participate in the provision of health care is an awesome and wonderfully engaging enterprise. The health professions are meaningful professional careers. To enter the practice of health care is to enter in to a social contract with other practitioners, your patients, and the community in general. This social contract calls not only for a particular set of clinical skills but also appropriate ethical, legal, and social behaviors.

Like any other professional endeavor, the common area of practice belongs to each and everyone of us.  It is unthinkable and unwise to believe that some other group of specialist such as physicians will maintain the health care arena. The obligations of ethical conduct, community service, and the refinement of knowledge are not the obligations of the few but the many. Health care is a team effort, and the team is responsible for the outcomes.s. It is a common field where we labor, and, like any other field, it requires that all those involved in the harvest maintain the space so that we can come again, and when we finally finished, leave it to others who will replace us in the labor.

We are in the time of great change for health care. Rapid technological and social change has pushed the frontiers of health into uncharted territory. Many of the legal and ethical issues faced by health care providers are new. To make matters more complicated, this is also a time of legislative reform to the health care system where at times it seems the only thing that is truly stable is change.

This is a litigious age. Out patient populations have come to expect miracles that cannot be always delivered . Practitioners at times find themselves seemingly between two forces: unhappy patients, aggrieved relatives, and their lawyers versus the risk management department, other health care providers, clinical institution, and insurance companies. Practitioners are expected to conduct themselves in a manner that protects the patients and the institution they serve.

This dealt with several functions that can be listed under the headings of ‘small ethics’. While they do not deal with great life and death issues such as euthanasia, justice, or withholding/withdrawing life support, they are the daily stuff of modern practice. They come as a function of our role duty and are the price one pays for being a professional. as practitioners of health professions we have an obligation to our patients, our colleagues, and our profession to perform these necessary-albeit unpleasant-gate keeping tasks.


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