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ABSTRACT The practice of medicine increasingly poses obstacles to the cultivation of strong relationships between physicians and their patients. The current discussion of medical professionalism aims to identify some of these obstacles and to improve both the doctor-patient relationship and the quality of medical care. In this essay, we explore professionalism within the context of the relationship between physician and patient and examine the concrete actions, behaviors, and qualities that medical professionalism requires of physicians in today's challenging environment.
IN HIS 1925 ADDRESS TO Harvard medical students Dr. Francis Peabody cautioned that the practice of medicine was changing in ways that threatened to compromise patient care. Peabody noted that these changes were occurring at both educational and institutional levels. "The most common criticism made at present by older practitioners," he remarked,"is that young graduates have been taught a great deal about the mechanism of disease, but very little about the practice of medicine" (Peabody 1927).The problem, according to Peabody, was not simply that the emphasis in clinical education had shifted from patient to disease, but also that the very institutions in which physicians learned and practiced had become less intimate: "When a patient enters a hospital, one of the first things that commonly happens to him is that he loses his personal identity. He is generally referred to, not as Henry Jones, but as 'that case of mitral stenosis in the second bed on the left.'" Perhaps the central question Peabody raised was this: can physicians form personal doctor-patient relationships in impersonal institutions? The answer to that question is vitally important to the current discussion of medical professionalism which aims to improve the doctor-patient relationship and the quality of medical care in the United States.
Over the last century medicine has grown increasingly specialized, mechanized, and impersonal, and the warnings issued by Peabody ring even truer today. Although Peabody did not coin the term "medical professionalism," he extolled many of the qualities that have come to be associated with it, namely, altruism, compassion, empathy, primacy of the patient, and commitment to medical expertise. In this essay, we explore medical professionalism within the context of the relationship between doctor and patient by examining the concrete actions, behaviors, and qualities that medical professionalism requires of physicians...