Obstacles to Medical Professionalism

To the Editor:

Dr. Charles S. Bryan made several good observations about the motivations of Generation X.¹ His statement, however, that the medical profession finds it difficult to honor professionalism because society doesn't honor it is misleading. It is only partly correct.

If society doesn't honor our professionalism, it is because for decades the medical profession has consistently paid more attention to the scientific accomplishments of physicians than to the humanistic qualities they demonstrate in their clinical practices.

This is worsened by the multitude of obstructions that stifle the cultivation of humanism by robbing physicians of their peace of mind and their morale. One is insurance companies' control of doctors' practices and another is the threat of malpractice litigation. These are external threats, but there are internal ones as well.

My favorite is the recertification process. However much the Boards may deny it, they recertify physicians primarily on the basis of scientific competence and claim that recertification is an assurance of competence. This sends the message to physicians that if they are “boarded,” their professionalism is sufficient. This may be one cause of the lack of “personalism” that many patients complain is missing in medicine.

Yes, the younger physicians have a different take on professionalism, but it's too easy to exonerate the leaders of the profession. Where have their voices been during the past several decades? Medical humanism can be revived, and the members of Generation X can incorporate it into their redefinition of professionalism. However, medical educators and physicians in private practice must lead the way.

When the medical profession considers it proper to honor professionalism and personalism in medicine, young physicians will be motivated to accord these ideals the respect and distinction that they now give to commoditization and commercialism.

Edward J. Volpintesta, MD
Bethel, Connecticut