By James Smith

As we navigate current and future health care transitions, I am skeptical that our conventional understanding of medical professionalism will assist us.  We have defined and organized medical professionalism into list of codes, behaviors, and collective “group-think” to serve as an aegis to transient threats to the central role of the medical practitioner in historic and contemporary healthcare.  Or at least physicians have.  Professionalism, as a movement in medicine, arguably had its inception in this country with the organization of the American Medical Association (AMA).  The AMA’s initial agenda included a proprietary defense to the threat of “irregular” practitioners—those from alternative medical education pathways.  The central role of physicians in modern healthcare has been eroded by payers, the government, and the healthcare systems in which physicians find employment.  Or so physicians think.  In response, physicians have conveniently deployed “professionalism” as a shield against these threats, and the general threat of commercialism in medicine.¹ Furthermore, professionalism has been nuanced, expanded and rolled out as a discipline to be taught in medical education in order to protect and retain a collective identity, resistant to oversight or intrusive engagement from the outside.  The self-serving nature of the call for renewed professionalism and its incorporation into medical education is thinly veiled by the allure (and illusion) that it may actually be effective.  All we are accomplishing is the depersonalization the very nature of the relationship between healer and patient upon which we “profess” our social vocation…
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