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Educación Médica

versión impresa ISSN 1575-1813

Educ. méd. vol.9 no.3  sep. 2006




Medical Professionalism - a Global Headache

Profesionalismo médico; una problemática global



Profesor Andrzej Wojtczak MD., PhD



Virtually everyone agreed that medicine is a moral enterprise, a profession whose members are adhered to a set of such timeless principles as respect for others, empathy, compassion, honesty and integrity, altruism and professional excellence. They are at roots of concept of medical professionalism, being the foundation of collective contract with society that traditionally has made medicine different from another professions or business.

The Hippocratic Oath: "I will use treatment to help the sick according to my ability and judgment; I will keep them from harm and injustice" has indicated for ages an essence of doctors’ ethics i.e. primacy of patient's benefit. Beside that almost 2,500 years ago, Plato in his Book IV of The Laws recognized that a good doctor-patient relationship is the foundation of medical practice. He describes the inadequate doctor-patient relationships as a "slave medicine," when "the physician never gives a slave any account of his complaints, nor asks for any; he gives some treatment with an air of knowledge in the brusque fashion of a dictator, and then is off in haste to the next ailing slave". The doctor-patient relationship is a mechanism of joint decisions when patient is placing his or her health in the hands of a particular physician who affirms his or her obligation to care for good of this patient.

Nowadays we are witnessing the advances of a corporate transformation of medical care with growing changes towards a more and more business-oriented health care system, where key values are cost, profit and competition. This creates a potential threat to reduce the status of patients to commodities rather than people with afflictions. Occurring recently allegations of malpractice and doctors’ incompetence, seen as their antisocial behavior, might endanger our medical professionalism as a moral enterprise to become indeed just another business profession.

As the response to these dangers in past years several important projects have been launched. Enough to mention the "Project Professionalism" developed by the American Board of Internal Medicine (ABIM, 1990), the "Medical School Objectives Project" by the Association of American Medical Colleges (1999), a focus on the professionalism given by the American Board of Pediatrics (2000) and the "Outcome Project" of the Accreditation Council for Graduate Medical Education (2000), a strong focus on "Professional Values, Attitudes, Behavior and Ethics" given in the GMER Project launched by the Institute for International Medical Education (IIME- 1999) and lastly published document by The Foundation for Medical Education and General Council of Medical Colleges "SER MÉDICO, HOY" outlining issues of medical professionalism in Spain (June 2006). It is important to stress the great importance of the 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 co-authored by representatives of Sweden, England, Switzerland, Italy, the Netherlands, France, Canada, and Spain the Charter on Medical Professionalism. All authors of this charter feel that the fundamental commitment of physicians to the welfare of their patients is being threatened as never before, and they reaffirmed of timeless principles: patient welfare, respect for patient autonomy, and social justice.

So, the medical education has the obligation to make students aware of these conflicts between traditional obligations and the imperatives of the market, so they are better prepared to defend their professional values in a new business climate.

Here, I want to associate myself with Dr. Jordan Cohen, past President of the Association of American Medical Colleges, who addressing the Annual Convention stressed "the present obligation of medical profession is to cultivate the core values of professionalism in future practitioners.... and stand firmly in support of the values that make our profession `honored and honorable."

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