J Korean Med Assoc.  2011 Nov;54(11):1124-1136.

Modern-day medical professionalism: historical background, evolution of the concepts, and a critique on the statements

• Choi B

Abstract

Modern day medical professionalism has been advocated by multiple professional organizations and individual scholars. Most of the statements publicly issued emphasize particular moral traditions and the highest professional standards along with doctors' social role to recover society's trust, which have proved ineffective in bringing any change. Based on the perspective that medical professionalism is a norm of practice, acknowledged and shared by the majority of current ordinary doctors, the author traced the emergence of modern professionalism to challenge the legitimacy of those virtue-based arguments within a historical context. With the increasing complexities of both society and the health care system, new types of health clinics have been practiced especially by young generation doctors. As these are explored, several factors related with those stated professionalism that are creating conflicts are discussed. It is criticized that those statements demand individual doctors to adhere to the ideal professionalism regardless of any circumstances, so that it excludes any discussion about professionalism from the broader social contextual background. Given that professionalism is a context-dependent concept, it is stressed that modern day medical professionalism is required to evolve along with societal change. As medicine is recognized as a system in which numerous societal areas are involved, medical professionalism is expected to be rewritten into a consensus-based, more realistic and explicit compact.

Keyword

Medical professionalism; Altruism; Medical commercialism; Conflict of interest

MeSH Terms

Altruism
Conflict of Interest
Delivery of Health Care
Evaluation Studies as Topic
Illegitimacy
Societies

Reference

1. Sigerist H. Civilization and disease. 1915. Ithaca: Cornell University Press.

2. Abraham F. S Kim . Medical education in the United States and Canada: a report to the Carnegie Foundation for the advancement of teaching. 2005. Paju: Hangilsa.

3. Edelstein L. The Hippocratic oath, text, translation and interpretation. 1943. Baltimore: Johns Hopkins Press.

4. Jonsen AR. A short history of medical ethics. 2000. New York: Oxford University Press.

5. Wynia MK. The short history and tenuous future of medical professionalism: the erosion of medicine's social contract . Perspect Biol Med. 2008. 51:565–578.

6. Baker R, Caplan A, Emanuel L, Latham S. The American medical ethics revolution: how the AMA's code of ethics has transformed physicians' relationships to patients, professionals, and society. 1999. Baltimore: Johns Hopkins University Press.

7. Paul S. JC Lee . The social transformation of American medicine. 1996. Seoul: Myeonggyeong.

8. Fox RC. HI Cho . The sociology of medicine: a participant observer's view. 1989. Seoul: Nanam.

9. Evetts J. The sociological analysis of professionalism: occupational change in the modern world. Int Sociol. 2003. 18:395–415.

10. Relman AS. The new medical-industrial complex. N Engl J Med. 1980. 303:963–970.

11. Kassirer JP. BM Choi . On the take: how medicine's complicity with big business can endanger your health. 2008. Seoul: Yangmun.

12. Lundberg GD. Medicine: a profession in trouble? JAMA. 1985. 253:2879–2880.

13. Hafferty FW, Levinson D. Moving beyond nostalgia and motives: towards a complexity science view of medical professionalism. Perspect Biol Med. 2008. 51:599–615.

14. Swick HM. Toward a normative definition of medical professionalism. Acad Med. 2000. 75:612–616.

15. ABIM Foundation. American Board of Internal Medicine. ACPASIM Foundation. American College of Physicians-American Society of Internal Medicine. European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Ann Intern Med. 2002. 136:243–246.

16. ACS Task Force on Professionalism. Code of professional conduct. J Am Coll Surg. 2003. 197:603–604.

17. American Academy of Pediatrics, Committee on Bioethics. Fallat ME, Glover J. Professionalism in pediatrics: statement of principles. Pediatrics. 2007. 120:895–897.

18. Kearney RA. Defining professionalism in anaesthesiology. Med Educ. 2005. 39:769–776.

19. Rowley BD, Baldwin DC Jr, Bay RC, Karpman RR. Professionalism and professional values in orthopaedics. Clin Orthop Relat Res. 2000. (378):90–96.

20. Woodruff JN, Angelos P, Valaitis S. Medical professionalism: one size fits all? Perspect Biol Med. 2008. 51:525–534.

21. Chung CW. Current situation of medical professionalism education in Korean medical schools. Korean J Med Educ. 2004. 16:259–267.

22. Shah N, Anderson J, Humphrey HJ. Teaching professionalism: a tale of three schools. Perspect Biol Med. 2008. 51:535–546.

23. Hilton S. Education and the changing face of medical professionalism: from priest to mountain guide? Br J Gen Pract. 2008. 58:353–361.

24. Cohen JJ. Professionalism in medical education, an American perspective: from evidence to accountability. Med Educ. 2006. 40:607–617.

25. Brennan TA, Rothman DJ, Blank L, Blumenthal D, Chimonas SC, Cohen JJ, Goldman J, Kassirer JP, Kimball H, Naughton J, Smelser N. Health industry practices that create conflicts of interest: a policy proposal for academic medical centers. JAMA. 2006. 295:429–433.

26. Campbell EG, Weissman JS, Ehringhaus S, Rao SR, Moy B, Feibelmann S, Goold SD. Institutional academic industry relationships. JAMA. 2007. 298:1779–1786.

27. Rothman DJ. Academic medical centers and financial conflicts of interest. JAMA. 2008. 299:695–697.

28. Rothman DJ, McDonald WJ, Berkowitz CD, Chimonas SC, DeAngelis CD, Hale RW, Nissen SE, Osborn JE, Scully JH Jr, Thomson GE, Wofsy D. Professional medical associations and their relationships with industry: a proposal for controlling conflict of interest. JAMA. 2009. 301:1367–1372.

29. Cohen JJ, Cruess S, Davidson C. Alliance between society and medicine: the publics stake in medical professionalism. JAMA. 2007. 298:670–673.

30. Lawson WD. Professionalism: the golden years. J Prof Issues Eng Pract. 2004. 130:26–36.

31. Hafferty FW, Castellani B. The increasing complexities of professionalism. Acad Med. 2010. 85:288–301.

32. Brainard AH, Brislen HC. Viewpoint: learning professionalism. A view from the trenches. Acad Med. 2007. 82:1010–1014.

33. Daniel M. Human, transhuman, posthuman: implications of evolution-by-design for human security. J Hum Secur. 2008. 4:4–20.

34. Sullivan P. Putting your doctor, or a whole team of them, on retainer. 2011. 04. 29. The New York Times;business section.

35. Bishop JP, Rees CE. Hero or has-been: is there a future for altruism in medical education? Adv Health Sci Educ Theory Pract. 2007. 12:391–399.

36. Karatani K. TW Song . Ethics 21. 2001. Seoul: Sahoepyeongnon.

37. Glannon W, Ross LF. Are doctors altruistic? J Med Ethics. 2002. 28:68–69.

38. The new doctors: guidance on foundation training [Internet]. General Medical Council. 2009. cited 2011 Oct 14. London: General Medical Council;Available from: http://www.gmcuk.org/New_Doctor09_FINAL.pdf_27493417.pdf_39279971.pdf.

39. Jonsen AR. IH Lee YJ Kim . The new medicine and the old ethics. 2007. Suwon: Munhwa Design.

40. Shaw K, Cassel CK, Black C, Levinson W. Shared medical regulation in a time of increasing calls for accountability and transparency: comparison of recertification in the United States, Canada, and the United Kingdom. JAMA. 2009. 302:2008–2014.

41. Chantler C, Ashton R. The purpose and limits to professional self-regulation. JAMA. 2009. 302:2032–2033.

42. Ham C, Alberti KG. The medical profession, the public, and the government. BMJ. 2002. 324:838–842.

43. Hafferty F. . Acad Med. 2006. 81:906–914.

44. Kinghorn WA, McEvoy MD, Michel A, Balboni M. Professionalism in modern medicine: does the emperor have any clothes? Acad Med. 2007. 82:40–45.

45. Definition of health [Internet]. World Health Organization. 2000. cited 2011 Oct 14. Geneva: World Health Organization;Available from: https://apps.who.int/aboutwho/en/definition.html.

46. Freidson E. Professionalism, the third logic. 2001. Chicago: University of Chicago Press.