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A Word From the PresidentSeeking Social Justice Through Medical Professionalism
If we are to beat back the forces of commercialism that are threatening to transform medicine into "just another business," we must become much more conscious of precisely what is meant by professionalism, and much more vigorous in championing its virtues. The roots of professionalism date back at least to Hippocrates and have been nourished over the centuries by countless philosophers and leaders in medical ethics. The core principles underlying professionalism have remained remarkably consistent over time, even as the specific commitments physicians have been called upon to make have adapted to the ever-evolving nature of medical practice. The latest effort to formulate those principles for contemporary practitioners is the Charter on Medical Professionalism developed by the American Board of Internal Medicine Foundation, the American College of Physicians-American Society of Internal Medicine Foundation, and the European Federation of Internal Medicine. In February, the charter was published simultaneously in both the Annals of Internal Medicine and the Lancet. It is also available at www.professionalism.org. This latest codification of medical professionalism has many commendable features, but two aspects are especially noteworthy. The first is the charter's recognition that current challenges to medicine's core ethical principles do not end at America's borders. Besides the United States, members of the Medical Professionalism Project who authored the charter represent Sweden, England, Switzerland, Italy, the Netherlands, France, Canada, and Spain. These countries exhibit widely diverse approaches to health care delivery, yet all members of the project feel that the fundamental commitment of physicians to the welfare of their patients is being threatened as never before and that a reaffirmation of our essential purpose is urgently needed to fortify the resolve of individual practitioners everywhere. The second and even more noteworthy feature of the charter is its extension of the core tenets from which the demands of professionalism arise. Like previous treatises on medical professionalism, the charter recapitulates and contemporizes two timeless principles: the primacy of patient welfare and respect for patient autonomy. But this charter's unique contribution emanates from its assertion of a third principle: social justice. In addition to calling on physicians individually to be trustworthy, to maintain their competence, to be honest in dealing with patients, to respect the confidentiality of patient information, and to promote the scientific practice of medicine, the charter also admonishes physicians to "individually and collectively strive to reduce barriers to equitable health care." Specifically, it enjoins individual physicians to take collective action to improve the quality of care, increase access to care, and commit to a just distribution of resources. In doing so, the charter breaks much-needed new ground by encouraging physicians to go beyond their responsi-bilities to advocate for individual patients and take a role in "public advocacy… without concern for the self-interest of the physician or the profession." Besides providing an ethical road map for those already in practice, the charter offers a valuable lesson plan for medical educators as they prepare the next generation of physicians for the daunting challenges to professionalism that lie ahead. We are unlikely to stave off the imposition of commercial processes into the purely business aspects of medicine. Quite the contrary, we should welcome the introduction of good business practices from the world of commerce into the organization and financing of health care. Such practices are essential if we wish to optimize the cost-effectiveness of the care we provide, increase its safety, improve its quality, reduce its variability, and expand its reach. These are the proper domains of commercialism. Where commercialism has no place, and where professionalism must prevail, is in the sacred domain of the doctor-patient relationship and in the value-laden domain of social justice. Were medicine to yield its moral high ground to commercialism in these arenas, it would thereby abandon all claims as a moral enterprise and would, indeed, be "just another business." Our job as medical educators is to ensure that our students and residents are fully apprised of what's at stake here and are armed with a robust understanding of the tenets and the expectations of professionalism. A good place to start is by reviewing and discussing the newly formulated Charter on Medical Professionalism.
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Contact Us © 1995-2008 AAMC Terms and Conditions Privacy Statement |
What,
if anything, makes medicine different from just another business?
Few would have even thought to pose such a question until fairly
recently. Virtually everyone agreed without question that medicine
is a moral enterprise, a profession whose members are privileged
to adhere to a set of timeless principles in fulfilling their collective
contract with society. But the question is clearly no longer moot.
Many now seem to think that medicine is indeed just another business,
and that "commercialism" rather than "professionalism"
should be the watch cry of physicians. 