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Letters

Medical Professionalism: Another View

We read with interest the paper by David Mechanic ("Managed Care and the Imperative for a New Professional Ethic," Sep/Oct 00). Mechanic joins the many others who have called for a new professionalism that will better address future issues. His analysis and guidance are consistent with what others have recommended on the subject.¹

However, we do have one point of contention. We believe that the new professionalism must include those elements of the old professionalism that gave it value. If medicine used Mechanic’s blueprint for the future as the basis of a new professionalism, it would ignore the traditional obligations of setting and maintaining standards, self-regulation, and, above all, the emphasis on altruism and service.

The value system that has served medicine and society during the past two centuries must be adapted to a new age and a new generation. Mechanic offers only a partial roadway to assist us. It is possible to reject the status quo while preserving what is worthwhile from the past.

Sylvia R. Cruess, Richard L. Cruess and Sharon E. Johnston

McGill University, Montreal, Quebec

NOTE

 

1. See, for example, R.L. Cruess et al., "Professionalism: An Ideal to Be Sustained," Lancet 356 (2000): 156–159[Medline]; W. Sullivan, Work and Integrity: The Crisis and Promise of Professionalism in North America (New York: Harper Collins, 1995); M. Wynia et al., "Medical Professionalism in Society," New England Journal of Medicine 345 (1999): 1612–1615; and R. Smith et al., "A Shared Statement of Ethical Principles for Those Who Shape and Give Health Care: A Working Draft Paper from the Tavistock Group," Annals of Internal Medicine 130 (1999): 143–147.[Abstract/Free Full Text]

I have no difficulty in agreeing that "the new professionalism must include those elements of the old professionalism that gave it value." The issue comes down to which elements gave it value.

I maintain that the core of medical professionalism should include patient advocacy, responsibility for population health, new patient partnerships, and participation in an evidence-based culture. I also recommended that "physicians and other interested groups require forums to think about appropriate norms and how to preserve a clinical perspective that protects patients’ interests," but we should not be prepared to leave the establishment of standards and regulation solely to physicians. Medicine should be encouraged to meet its traditional service and self-regulatory responsibilities, but we are well past the time when this is sufficient.

David Mechanic

Institute for Health, Health Care, Policy, and Aging Research, Rutgers University

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