Abstract
The medical profession, like other professions, has evolved to occupy a special position in society. Medical professionalism has key attributes that define a profession: the practitioners possess specialized knowledge, hew to an ethical framework, police their own profession, and practice their profession to the benefit of society. But the practice of medicine is changing. A decade into the twenty-first century, rapid advances in the fields of pharmacology, biochemistry, and medical technology have resulted in constantly evolving and improved diagnostic and therapeutic options. In the areas of medical knowledge and resources, the United States is a world leader.
At the same time, the environment of care and healthcare delivery systems are in flux. Multidisciplinary medical teams have replaced the paradigm of the hierarchical medical team led by an authoritarian physician with a new model of physician leadership based on collaboration. Managed or coordinated care is replacing traditional fragmented care. Still, perverse financial incentives continue to promote generous and even ineffective care options to those with resources while broader public health goals are neglected. Within the context of these challenges, the United States medical profession has not been able to translate the advantages of technical expertise and financial resources into excellence in actual healthcare outcomes across the population.
We review the current state of the medical profession in the United States against a framework of professionalism in the context of measurable real-world impact of the profession and make recommendations for reconciling the ideal of professionalism with the contemporary practice of medicine. We discuss forces that conspire against professional ideals and practices and make recommendations for the future. (In another chapter in this book, we discuss the role of medical school recruitment, curriculum, postgraduate training in improving professionalism in medicine.)
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References
AMA Code of Ethics, Opinion 2.068. Available at: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion2068.page.
American Medical Association. (2001). Declaration of professional responsibility: Medicine’s social contract with humanity. Available at: https://www.med.illinois.edu/depts_programs/ClinicalAffairs/Document/decofprofessional.pdf.
Bloche, M. G., & Marks, J. H. (2005). When doctors go to war. New England Journal of Medicine, 352(1), 3–6. doi:10.1056/Nejmp048346.
Brennan, M. D. (2010). Professionalism. International Journal of Dermatology, 49(10), 1210–1212. doi:10.1111/J.1365-4632.2010.04781.X.
Centers for Disease Control and Prevention. (2011). HIV prevention through care and treatment. Morbidity and Mortality Weekly Report, 60(47), 1618–1623. Retrieved from http://www.cdc.gov/mmwr/PDF/wk/mm6047.pdf.
Chimonas, S., Brennan, T. A., & Rothman, D. J. (2007). Physicians and drug representatives: Exploring the dynamics of the relationship. Journal of General Internal Medicine, 22(2), 184–190. doi:10.1007/S11606-006-0041-Z.
Dorsey, E. R., de Roulet, J., Thompson, J. P., Reminick, J. I., Thai, A., White-Stellato, Z., et al. (2010). Funding of us biomedical research, 2003–2008. JAMA: The Journal of the American Medical Association, 303(2), 137–143.
Friedson, E. (2001). Professionalism: The third logic. Chicago: University of Chicago Press.
Gerhardt, R. T. (2011). Prehospital and emergency care research at the us army institute of surgical research: Enabling the next great leap in combat casualty survival. U.S. Army Medical Department Journal, 82–6.
Iglehart, J. K. (2012). Financing graduate medical education – Mounting pressure for reform. New England Journal of Medicine, 366(17), 1562–1563. doi:10.1056/Nejmp1114236.
Institute for Medicine as a Profession. (NEEDS DATE OF ACCESS). Professionalism in medicine – The imap agenda. Retrieved NEEDS DATE OF ACCESS, from http://www.imapny.org/medicine_as_a_profession/professionalism-in-medicine---the-imap-agenda.
Jones, J. M. (2011). Record 64 % rate honesty, ethics of members of congress low. Retrieved March 6, 2014, from http://www.gallup.com/poll/151460/record-rate-honesty-ethics-members-congress-low.aspx.
Murray, C. J. L., & Frenk, J. (2010). Ranking 37th-measuring the performance the US health care system. New England Journal of Medicine, 362(2), 98–99. doi:10.1056/Nejmp0910064.
Navarro, V. (2001). World health report 2000: Responses to Murray and Frenk. Lancet, 357(9269), 1701–1702. doi:10.1016/S0140-6736(00)04827-3.
NPR, Robert Wood Johnson Foundation, Harvard School of Public Health. (2012). Poll: Sick in america summary. Retrieved from http://www.npr.org/documents/2012/may/poll/summary.pdf.
OECD. (2013). OECD health data 2013: How does the United States compare. Retrieved from: http://www.oecd.org/unitedstates/Briefing-Note-USA-2013.pdf.
Pizzo, P. (2001). The changes in health care finance give new meaning to ‘conflict of interest.’ Stanford Medicine. 18(2), fall. Available at: http://stanmed.stanford.edu/2001fall/secondopinion.html.
Reid, L. (2011). Medical professionalism and the social contract. Perspectives in Biology and Medicine, 54(4), 455–469.
Relman, A. S. (2001). Separating continuing medical education from pharmaceutical marketing. JAMA: The Journal of the American Medical Association, 285(15), 2009–2012. doi:10.1001/Jama.285.15.2009.
Relman, A. S. (2007). Medical professionalism in a commercialized health care market. JAMA: The Journal of the American Medical Association, 298(22), 2668–2670. doi:10.1001/Jama.298.22.2668.
Relman, A. S. (2008). Industry support of medical education. JAMA: The Journal of the American Medical Association, 300(9), 1071–1073. doi:10.1001/Jama.300.9.1071.
Relman, A. S. (2009). Doctors as the key to health care reform. New England Journal of Medicine, 361(13), 1225–1227. doi:10.1056/Nejmp0907925.
Roland, M., Rao, S., et al. (2011). Professional values and reported behaviours of doctors in the USA and UK: Quantitative survey. BMJ Quality and Safety, 20, 515–521.
Simon, S. (2012). Annual report: More than a million cancer deaths avoided in 2 decades. Retrieved from http://www.cancer.org/cancer/news/news/annualreport-more-than-a-million-cancer-deaths-avoided-in-2-decades.
The ABIM Foundation, A.-A. F., & The European Federation of Internal Medicine. (2002). Medical professionalism in the new millennium: A physician charter. Annals of Internal Medicine, 136(3), 243–246.
The Commonwealth Fund Commission on a High Performance Health System. (2011). Why not the best? Results from the national scorecard on U.S. Health system performance, 2011. New York: The Commonwealth Fund.
World Health Organization. (2000). The world health report - Health systems: improving performance. Available at http://www.who.int/whr/2000/en/index.htmlm.
Wynia, M. K. (2008). The short history and tenuous future of medical professionalism the erosion of medicine’s social contract. Perspectives in Biology and Medicine, 51(4), 565–578.
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Allen, S.A., Olds, G.R., Schiller, N.L. (2015). Medical Professionalism and the Relevance and Impact of the Profession on Society. In: Mitchell, D., Ream, R. (eds) Professional Responsibility. Advances in Medical Education, vol 4. Springer, Cham. https://doi.org/10.1007/978-3-319-02603-9_3
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DOI: https://doi.org/10.1007/978-3-319-02603-9_3
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