Professionalism in the practice of medicine

Although medicine is universally recognized as the archetype of the professions, it can only be understood as part of the modem medical center, a dynamic social system consisting of the university, the hospital, the medical center and, most recently, corporate managed care. Such a view results in a portrait of medicine as a profession transformed, driven by huge and growing health care markets, its fate tied not only to state bureaucracies, but also to the dynamics of both health and non-health care businesses. The question asked here is how does such a radical change in medical practice affect medical education. Using methods of historical analysis, it appears that medical educators operate as though the educational process itself determines the values, and therefore the present and future behavior of their students. In other words, at the end of their formal education, doctors are fully formed professionals. However, from the analysis of this paper it can be concluded that the physician as an individual cannot function independently of the structure of the society and its general conception of the world. In the structure of medicine's present situation, the ethical standards of professionalism, as they are classically defined, cannot survive. Instead, modem medical graduates, much like their teachers and professional mentors, will be forced to adapt to a situation that is contradictory to the best traditions of medicine. How to stop this process is the urgent question. Three answers are presented.