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Charter on Medical Professionalism: Putting the Charter into Practice
- Richard L. Cruess, MD; and
- Sylvia L. Cruess, MD
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•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
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Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
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IN RESPONSE:
Dr. Lyons has identified an essential element in the relationship between medicine and the society it serves. In the presence of a social contract, society has every right to expect that medicine will meet societal expectations under the contract, but medicine also can rightfully expect certain actions by the society it serves. The nature of the contract has changed dramatically over the past 150 years. Up until World War II, medicine largely determined public policy, controlled the health care marketplace, exercised great authority, and was given responsibility for the health care systems in the developed world. During the past 50 years, health care has changed from a cottage industry to a complex activity consuming a substantial portion of the gross domestic product of most countries. Sociologists have noted the growth in the power of both the state and the marketplace (depending on the country and the structure of the health care system) and a concomitant weakening of medicine's influence. Thus, what society expects of medicine has not changed much, but under the contract, both the state and the marketplace began to exert authority over the structure of the system. As a result, the conditions under which physicians practice have changed. Without question, the medical profession now feels undervalued, threatened, and, at times, unable to deliver appropriate care. It wishes greater influence over public policy, and a health care system in which its expertise is recognized and used.
Along with a loss of influence has come a well-documented loss of trust in the profession. If the profession is to have significant input into public policy (the social contract), it must be trusted. The charter, Project Professionalism(1), and many other actions taken by medical associations, educational institutions, and licensing bodies are aimed at reestablishing trust. The charter is a statement of what medicine stands for. If physicians take note of the charter and govern themselves using it as a benchmark, one can hope that the profession will be more trusted and that the social contract will be altered in ways that answer Dr. Lyons' very justifiable concerns.
Richard L. Cruess, MD
Sylvia L. Cruess, MD
Center for Medical Education, McGill University; Montreal, Quebec H3G 1Y6, Canada
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
