We agree that physicians should embody the values, attitudes, and behaviors that compose Dr. Reynolds' definition of professionalism [1] but question the reliance on historical anecdotes to guide us toward these goals. Doing so risks ignoring the negative aspects of professionalism (for example, elitism and paternalism) [2], misrepresenting the past, and creating unrealistic expectations of today's physicians. In the past, physicians may have viewed medicine as a "calling," but portraying this as the ideal devalues the personal and professional well-being of individual physicians. Although historical traditions can be instructive, medicine and society are better served by focusing on the dynamics of a rapidly changing health care system and viewing them as opportunities for redefining physicians' roles.

The author's suggestions for "creating" an educational community through curriculum reform disregard contemporary challenges facing academic medical centers, including changing funding patterns and the growth of managed care [3]. Layering specific programs (for example, seminars on medical professionalism) onto an already burgeoning medical course load cannot begin to counteract the hidden curriculum in which "the informal lessons of action and deed teach more than the intended lesson of the didactic offering" [4]. A fundamental shift in institutional culture is essential to promoting lasting changes in the values, attitudes, and behaviors of physicians-in-training. As a starting point, institutions can objectively appraise their mission and curricula (both explicit and implicit) [4]. These efforts need to be combined with changes in federal and state policies toward medical education [5]. Those of us who share Dr. Reynolds' goals for the medical profession need to embrace this broader agenda.