The definition of medicine in the dictionary gives equal weight to the terms science and art. We chose to become internal medicine physicians to apply knowledge gained through research in the direct care of unique individuals with complex problems.
Core to both the science and the art of medicine is medical professionalismour simultaneous responsibility to our patients, our community and the entire healthcare system. Professionalism focuses physician responsibility on the relationship between doctors and their patients. It also challenges medical professionals to be stewards of limited resources while serving the best interests of patients. And, at this critical time of openness to new approaches to health reform, there may be a central role for medical professionalism in achieving healthcare that is equitable, affordable and high quality.
But, for many outside the field of medicine, medical professionalism is a vague concept that has little meaning. In fact, some have argued that physicians use the concept of medical professionalism to protect themselves from accountability. Physicians, however, believe that medical professionalism is the fundamental backbone of accountability and the basis of medicines contract with society. It drives the efforts of physicians to become more responsible managers of scarce resources, and to engage more assertively in efforts to improve the systems in which we care for our patients.
In 2002, the American College of Physicians and the American Board of Internal Medicine worked with the European Federation of Internal Medicine to create the Physician Charter on Medical Professionalism. Endorsed by more than 100 medical societies worldwide, the charter embraces three principles of professional responsibility that our healthcare system must also support: promoting patient welfare, respecting patient autonomy and achieving social justice.
We know that physicians are not perfect. A study published in the Annals of Internal Medicine in 2007 found that while physicians support the idea of medical professionalism, some have trouble living up to those ideals. For instance, while 96% believe that patient needs trump financial interests, 24% of physicians say that they would refer a patient to an imaging facility they ownwithout informing that patient of the potential conflict.
While we believe it is the responsibility of the individual physician to live up to the ideals of professionalism, the system in which they workwith pay-for-performance, fee-for-service or other structurescan create perverse incentives that may not support a physicians best efforts to uphold the principles of medical professionalism: acting with respect, honesty and transparency with their patients. We need to explore how health reform can support physician professionalism in daily medical practice and serve the best interests of our patients.
Physicians also need to acknowledge and embrace an expanded notion of professionalism that includes taking responsibility with their patients for both the individual patient and the population at large.
Take comparative-effectiveness research. The $787 billion economic stimulus package includes $1.1 billion for comparative-effectiveness research to evaluate the clinical effectiveness of two or more medical services, drugs, devices, therapies or procedures used to treat the same condition.
Comparing different treatments to find out which work best for different patients could enhance health and save lives by giving doctors and patients evidence-based information to make important healthcare decisions. We disagree with criticssome of whom are physicianswho worry that comparative-effectiveness data could be used to limit care or deny services. Because one-size treatments do not fit all, sound policies must be put in place to ensure that the physician puts the patient first.
Increasing funding for comparative-effectiveness research is a step in the right direction for improving healthcare and should be an integral part of healthcare reform. In the best possible world, the comparative-effectiveness research would support physicians in their efforts to give patients the information they need to make informed choices and to communicate the implications of decisions. We are pleased that the Institute of Medicine is spearheading research to examine priorities in this area, and are proud to be part of an effort that brings together diverse stakeholders, including physicians, health plans and consumer and patient organizations.
Our nation faces a multifaceted challenge in implementing healthcare reform: making health insurance affordable and accessible to all; ensuring that there are enough doctors, including primary-care doctors, to take care of the existing and newly insured; and improving quality. Reform provides an opportunity to engage patients and physicians in shaping a system that serves patients well and fosters trust and medical professionalism.
As we explore healthcare reform moving forward, we must ensure that such reform policies are aligned with the principles of medical professionalism and that they are supported by sound researchthe science of medicineand an awareness of the unique role of the patient/physician relationshipthe art of medicine.
Christine Cassel, M.D.PresidentAmerican Board of Internal MedicineJeffrey Harris, M.D.PresidentAmerican College of Physicians Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.