The good doctor: professionalism in the 21st century

Abstract

Medical professionalism faces distinctive challenges in the 21st century. In this chapter, we review the history of professionalism, address specific challenges physicians face today, and provide an overview of efforts to address these issues, including behavioral and virtue ethics approaches. First, we discuss core features professions share and the development of codes of medical ethics that guide the practice of western medicine. Second, we address challenges related to the doctor-patient relationship, continuity of care, cultural competence, conflicts of interest, and the regulation of quality of care through maintenance of certification. We then explore three cultural trajectories that have deeply influenced medical practice: the technologic imperative, physicians' collective neglect of structural factors impacting medicine, and the rise of commercialism. Finally, we describe efforts to address these challenges, focusing on the Physician Charter developed by the American Board of Internal Medicine and widely endorsed by medical boards and societies internationally.

Keywords: commercialism; conflicts of interest; continuity of care; cultural competence; doctor–patient relationship; medical education; medical ethics; professionalism; technologic imperative.