Professionalism

Viewpoint: Professionalism and Humanism Beyond the Academic Health Center
Herbert M. Swick, MD

Abstract
Medical professionalism and humanism have long been integral to the practice of medicine, and they will continue to shape practice in the 21st century. In recent years, many advances have been made in understanding the nature of medical professionalism and in efforts to teach and assess professional values and behaviors. As more and more teaching of both medical students and residents occurs in settings outside of academic medical centers, it is critically important that community physicians demonstrate behaviors that resonate professionalism and humanism. As teachers, they must be committed to being role models for what physicians should be. Activities that are designed to promote and advance professionalism, then, must take place not only in academic settings but also in clinical practice sites that are beyond the academic health center. The author argues that professionalism and humanism share common values and that each can enrich the other. Because the cauldron of practice threatens to erode traditional values of professionalism, not only for individual physicians but also for the medical profession, practicing physicians must incorporate into practice settings activities that are explicitly designed to exemplify those values, not only with students and patients, but also within their communities. The author cites a number of examples of ways in which professionalism and humanism can be fostered by individual physicians as well as professional organizations.
Acad Med. 2007; 82:1022–1028.

merit a great deal of attention, to provoke dialogue and debate, and to challenge practicing physicians, medical educators, and others involved with contemporary health care. During the past decade or so, important advances have been made both in understanding the nature of professionalism1– 4 and in efforts to teach and assess professional values and behaviors in undergraduate and graduate medical education.5– 8 A number of specialty boards and societies, such as the American Board of Internal Medicine, have focused on ways to foster and document professionalism among practicing physicians.9 On balance, however, less attention has been given to the practical challenges and expressions of medical professionalism in practice settings than in academic settings.
The Nature of Professionalism

Medical professionalism continues to

scope of this article, or even this special issue of Academic Medicine. The complexity of contemporary medical practice drives the complexity of medical professionalism and confounds a simple, universally accepted definition. Medical professionalism has many dimensions, from a distinction between basic and higher professionalism,10 to the necessary competencies of a social contract,2 to conditions necessary for ethical practice.11 Each dimension is valid, but none is sufficient to fully define the nature of professionalism. Professionalism and values One fundamental dimension of professionalism relates to the values that have long shaped the practice of medicine. For the past few decades, the practice of medicine, as a profession, has come under withering fire from many directions. Physicians, individually and collectively, have felt threatened and besieged. The increasing focus on professionalism has been perceived as a defensive response, an effort to defend the bulwarks of the profession (my warlike allusions are chosen quite deliberately). Stevens11 (p359) has noted that professionalism has assumed, in some quarters, an almost mythic dimension to become a “powerful, formulaic way of thinking.” She notes, correctly, that “professionalism . . . can no longer be taken for granted as a core

of behavioral expectations that are inherent in becoming a physician.”11 (p357) If those of us who are concerned about the future of medicine are to restore and maintain professionalism, we must—slowly, perhaps, but inevitably—abandon the current reactive and defensive posture and make professionalism a positive, lived expression of the values that have for so long characterized the profession of medicine. These values must infuse not only educational settings but also practice sites. Professionalism, then, must be grounded in the long-standing values of medicine. The practice of medicine is a sacred trust; ideally, it represents not a contract but a covenant.3 A covenant connotes a relationship based on trust, and the covenantal nature of medicine has been reflected in medical oaths since ancient times. The Hippocratic oath addressed the physician’s duty to benefit the sick and keep them from harm and injustice.12,13 The Prayer of Maimonides states “in the sufferer let me see only the human being.”14 A more contemporary medical oath calls on a physician to “act so as to preserve the finest traditions of my calling.”15 Now, in the 21st century, we must endeavor to refresh the meaning of medicine as a covenant between physicians and those they serve by upholding these finest traditions and

An exhaustive discussion of medical professionalism is clearly beyond the

Dr. Swick is research professor, College of Health Professions and Biomedical Sciences, The University of Montana, Missoula, Montana; clinical associate professor, Department of Medicine, University of Washington School of Medicine, Seattle, Washington; and former executive director, Institute of Medicine and Humanities, Missoula, Montana. Correspondence should be addressed to Dr. Swick, 4 Brookside Way, Missoula, MT 59802; telephone: (406) 542-6560; e-mail: (hmlswick@msn.com).

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23 even though professions. must frame the practice of medicine. reflecting simply the numbers of physicians in practice versus the number in academic medicine. Some have expressed concern that. as well as formal clerkships during the clinical years. As Stern and Papadakis8 (p1797) have noted. Far from it: each can enrich the other. it must frame the practice of medicine. Further. with patients. so. as well as pedagogical methods drawn from the humanities. expertise then becomes the norm against which professionalism is judged. such humanistic values. explicitly or implicitly. humanism is exemplified through compassionate. As more and more teaching of both students and residents occurs in such locations. .1–3.”16 (p141) Scribonius. opportunities to foster the further development of such foundations during undergraduate and graduate medical education. We must find ways to minimize the erosion and Academic Medicine. in part. is credited with the first written use of the word profession in a book of prescriptions from 47 AD. Professionalism and humanism There is in medicine a critical nexus between professionalism and humanism. Professionalism Outside the Academic Health Center maximize the stimulation.19 (p5) convey the importance of humanism. too. In an almost analogous fashion.24 The cauldron of practice can erode or. as well as the transformation of medical practice from a professional to a business model. so too are efforts to do so in practice sites. the values of professionalism can help The values of professionalism are the same inside and outside the academic environment. or professional organizations such as specialty societies. to incorporate into practice settings activities that are explicitly designed to restore. nevertheless. especially medicine. and with our communities. and assess medical professionalism have occurred within institutional settings such as schools of medicine. including full acceptance of all cultural and ethnic backgrounds. Insofar as professionalism has a moral core and encompasses values that are intrinsic to all humans. Medical educators and leaders must find ways to integrate and suffuse both professionalism and humanism throughout the curriculum. Although one can argue that an individual’s ethical and moral foundations are well established by the time he or she enters medical school. and advance professionalism and humanism in medicine. Appropriately.17 Many contemporary discussions of professionalism also address. empathetic treatment of all persons while recognizing each one’s needs and autonomy. in basic science and clinical settings. . stimulate professionalism. Both have long been “inextricably woven into the practice and art of medicine. or that professionalism is conflated with humanism. . 11 / November 2007 1023 . a certain amount of formal clinical experience now occurs at sites remote from the academic health center. In defining profession as “a commitment to compassion or clemency in the relief of suffering. practicing physicians too often complain that the current health care environment and the pressures of contemporary practice leave no time for other pursuits. A professional education must address specific knowledge. The Gold Humanism Honor Society offers a succinct definition: Humanism encompasses those attitudes and behaviors that emanate from a deep sensitivity and respect for others. The challenge becomes even more daunting when the goal is to institute an attitude of professionalism in multiple organizations. and expertise. literary giants of our experience. professionalism is supplanting humanism. One element driving the concern about a loss of professionalism has been the rapid advances in medical science and technology that have come to characterize contemporary medical practice. as well as attitudes and what Thomas Green21 (p109) has called an imaginative conscience. Such experiences convey powerful messages about the nature of medicine as a practice and the roles of the physician. When expertise drives professional work. It is critical. cynical students who consider time spent discussing professionalism or humanism an unnecessary distraction from what they need to learn for their next exam. does the word humanism. by a growing sense of alienation and loss of meaning among practicing physicians.25 Although efforts to embed professionalism in schools of medicine and academic health centers are key. perhaps especially to doubting. No. In most medical schools. 82. Such activities can occur in at least three spheres: with students.18 Just as the word professionalism carries many connotations. Medical educators must ensure that medical students and residents are prepared for the world in which they will practice and the communities they will serve. . it. a physician in the court of the Roman emperor Claudius. respond to a “fundamental human need or social good whose advancement is already a moral aim. Professionalism and students There is a long-standing debate about whether values can be taught.” Scribonius emphasized humanistic values such as benevolence and compassion. promote. through exposure to the “poets and . Conversely. Vol.” Students considering a career in medicine not infrequently spend time in a physician’s office to “shadow” the physician and gain exposure to contemporary medical practice. at least in undergraduate medical education. residency review committees. there are. therefore. can be used to help convey the values of professionalism. Professionalism must be taught. it is critically important that community Insofar as humanism addresses the question of what it means to be human.22. Hence. practicing physicians can begin to mold humanism and professionalism in a very early stage of a medical student’s professional development. less likely. “students need to see that professionalism is articulated throughout the system in which they work and learn.”21 (p79) The resurgent interest in medical professionalism has also been driven.” Humanistic values. including defined experiences with community physicians during the early stages of medical education.20 I would argue that the two are not mutually exclusive. inculcate. most of the efforts to understand. and in practice sites as well as academic health centers.Professionalism endeavoring always to see only the human being in those who suffer. Daily expressions of professionalism occur most frequently not in the academic health center but in physicians’ offices and in the communities they serve. skills. too. .

when physicians are beset with multiple and often conflicting demands. but also in their manifold responsibilities as members of their communities.”8 (p1797) Another feature of the nonacademic setting is that there can be. healing relationship. by the nature of the learning environment. In recent years. it is important to remind ourselves that humanistic and professional values truly do continue to shape the healing relationship between patient and physician. . and it need not take a great deal of time. . Outside academic health centers. constructive formative assessments. of Sagacity. but only if one can engage practicing physicians as effective mentors and role models. patients can become advocates for their own physicians.26. and in the hovels of the poor. personal relationship that impels healing. More than a century later. Students are very sensitive to inherent conflicts between what is taught and what is observed. or the pediatrician who helps coordinate a local food drive. In this brief statement. said in a 1903 address to students who were about to embark on careers as practicing physicians: Yours is a higher and more sacred duty. .6. must be expressed not only in their daily interactions with patients and other health care professionals. Perhaps it is the orthopedist who volunteers as team physician for the high school football team. but also a social and cultural community. but also a neighborhood. they must be committed to being role models for what physicians should be. and broad charity to all. Despite the challenges of the current health care practice environment. the grammar and syntax may seem a bit outmoded. infinite pity to the suffering. Patients. The ultimate beneficiaries of the patients’ advocacy will be not only individual physicians but also the profession. Professionalism and community Traditionally. that will show in your daily life tenderness and consideration to the weak. By making time to be active in their communities. not only a specialty society. and wish there were some way to restore it. a sense of social contract. they will increase trust and strengthen the covenantal nature of medicine. then. but the message is as pertinent as ever. to you is given the harder task of illustrating with your lives the Hippocratic standards of Learning. participating members of the communities in which they live.28 (p274) the first professor of medicine at the Johns Hopkins University School of Medicine in the late 19th century. certain dimensions of medical professionalism—such as its implicit social contract— demand that physicians be active. I do not say this to detract from the critical importance of evaluating professional behaviors or from the need to train all faculty to make those evaluations. not only a scientific community. because we are A Few Practical Ideas Within academic settings. there are clear opportunities to integrate issues of professionalism and humanism into the curriculum. and such physicians can play an active role in restoring an environment of professionalism in practice. and an acknowledged avatar of professionalism. or the infectious disease specialist who is a consultant to the local county board of health. in the homes of the rich. Professionalism and patients The ultimate beneficiary of a physician’s professionalism and humanism is the patient. in the slums of our large cities. The use of the plural communities is deliberate. great strides have been made in assessing the professional behaviors of medical students. of Humanity and Probity. . No. or the general surgeon who serves on the medical staff quality committee.27 Nevertheless. formative feedback that can derive from modeling and discussing the professional and cultural values that students encounter in clerkship settings away from the academic health center. Nonacademic settings such as physicians’ offices and community hospitals can be excellent venues to address professionalism. Patients. may sense acutely the loss of the intense.7 We know that negative faculty judgments are associated with later disciplinary action by state licensing boards. too. then. they have long been seen as integral members of their communities. and he acknowledged the difficulty of exemplifying those dimensions in the daily life of a physician. Perhaps it is the pathologist who sings in a community choir. in doing so. 1024 Academic Medicine. even though they are willing to make useful. but in today’s challenging health care environment. but most cite real. in villages and country districts. all members of many communities—not only a city or town. although doing so successfully can be most challenging. like physicians. but rather to emphasize the importance as well of informal. physicians demonstrate professionalism. Osler alluded to several of the dimensions of professionalism. . how can physicians and other health care professionals best promote their professions’ values and the attributes of professionalism and humanism? There are many ways to do so. many clinical volunteer faculty may feel uncomfortable making summative judgments about a student’s professionalism after limited interactions. personal experiences. Physicians must be advocates for their patients. in the mining camps and factory towns.29 Many medical schools now have formal programs designed to foster professionalism and to introduce students to the importance of the humanities. and “efforts to teach the ideals of professionalism can be easily overwhelmed by the powerful messages in the hidden curriculum. As teachers. This seems an almost unnecessary statement of the obvious. can speak up for physicians who nurture a personal. physicians have served as much more than caregivers. . This expression can take many forms. Vol. Physicians’ professionalism. Perhaps it is the family medicine physician who plays in the local community symphony orchestra. So. To you the silent workers of the ranks. and humanistic values. They are meant simply to exemplify the concepts and stimulate additional ideas. Communities respond by welcoming physicians as an essential element of life beyond simply the world of illness. if not always cure. the internist who serves on the board of the local YMCA. including competence. many opportunities to nurture professionalism without the constraints imposed by formal assessment. William Osler. 11 / November 2007 . The following examples are empiric rather than evidence based. Of a humanity. 82. but also the profession.Professionalism physicians demonstrate those behaviors that resonate professionalism and humanism. Other articles in this special issue of Academic Medicine address some of the innovative approaches that have been used.

poverty. to B. while also pursuing their careers as writers. Edgar and Pattison31 (p98) have noted that “the humanities . are works by physician writers—individuals who maintained an active practice. make those values and meanings explicit and attractive. I pass the night with the other . and social justice. graduate. personal. Other recent IMH conferences have addressed topics such as depression. shame. King (“The beautiful thing about learning is that nobody can take it away from you”). When I grow weary of one. highlighting common threads of stigmatization. health care and public settings outside an academic health center.32 Bringing together a broad range of hospital personnel. The program’s success is attested to by its extension to 79 health care facilities in Maine. as well as hospitals in 13 additional states. and drama. One evening a week for four weeks. In 2005. the IMH sponsored a series of conferences called Taking Missoula’s Pulse: Steps Toward a Healthier Community. are the humanities anything more than “a leisurely distraction from the real work of diagnosing and curing”?31 (p94) Emphatically. from medical staff physicians and nurses. Public conferences. seminars specifically designed for health care professionals. In 1997. personal communication. Vol. a joint program of The University of Montana and St. and ethical implications of recent advances in genetics. They become the poets and literary giants of our experience. and the impact of these issues on all of us. posters containing brief epigrams highlighted the roles of the physician as teacher and learner. a series of seminars for hospital staff facilitated by a humanist scholar. The SCCM was thus able to highlight two important professional responsibilities of physicians—teaching and lifelong learning—without a great deal of energy or expense (Diane Scott. Patrick Hospital and Health Sciences Center in Missoula. Examples drawn from the humanities often enriched the presentations. using examples that quietly but powerfully express various dimensions of professionalism and humanism in practice. body image. as academic physicians or private practitioners. the specific readings were selected to target issues that were pertinent for the particular hospital. to laboratory technicians. Literature can be a powerful way to convey the values of professionalism and humanism. to members of the administration.B. . and a similar program was created for two smaller hospitals in other Montana communities.Professionalism Ideas for structured humanities programs The Institute of Medicine and Humanities (IMH). 2007). In the context of today’s busy.” Works by physician writers offer insights not only into the experience of being a physician. . Ideas for professional organizations Professional organizations can promote professionalism in ways that are both direct and indirect. Academic Medicine. 82. neither of them suffers because of my infidelity. . For example. Public conferences can help express the values of professionalism and humanism by addressing topics of importance to the community. 11 / November 2007 1025 . and the uninsured. allow a community to scrutinize its own values and meanings. Ideas for individual physicians To make my points more vividly. frenetic practice environment. Although such IMH conferences are designed for the public. addiction. These and similar brief statements engaged the participants’ interest and stimulated informal conversations among the physicians in attendance. the Maine Humanities Council launched Literature and Medicine: Humanities at the Heart of Health Care. the IMH has endeavored to better understand the human dimensions of health care by using the humanities to address health care issues that challenge our understanding of what it means to be human and by advancing scholarship in the medical humanities. using themes found in short fiction. . they attract health care professionals as well. I introduced and led a literature and medicine seminar series at St. is one effective model of how professionalism and humanism can be promoted in educational. . but action”). in this section of my article. I speak not about physicians but as a physician. 20 hospital staff and physicians came together for informal but provocative conversations that centered on common experiences of illness and healing. whether or not they were engaged in direct patient care. and very selective list of works that I have used in various settings to provoke reflection and insight about the very human nature of the practice of medicine. . Courses and lectures for undergraduate. mental illness. One evening a month for six months. In hallways and meeting rooms throughout the meeting site. even though they did not deal directly with the medical and scientific aspects of critical care. to Herbert Spencer (“The great aim of education is not knowledge. as well as other health care providers. Examples ranged from Nelson Mandela (“Education is the most powerful weapon which you can use to change the world”). It is easy to envision similar approaches at meetings of other professional organizations. One senior internist commented after the session on violence that she had never heard patients speak so openly. made valuable contributions. as specialists or generalists. Anton Chekhov33 famously noted that “medicine is my lawful wife and literature my mistress. using all new readings. Patrick Hospital and Health Sciences Center in Missoula. these seminars employ selected works of literature to stimulate an engaged dialogue that crosses the usual boundaries of health care hierarchies.” Seminars for health care professionals. Patrick Hospital. yes! The humanities can serve to enable dialogue between physicians and patients. emphasizing how much insight she had gained into problems that confronted some of her patients. Especially useful. No. The Appendix offers a small. and panels of patients added a powerful and personal perspective. The seminar was repeated in 2006 at St. In each case. to Michelangelo (“I am still learning”). whereas the arts . and health professions students at the University of Montana. to ensure relevant discussions. local authorities addressed issues such as violence. but also into the human condition and the experiences of illness and suffering. and at least one major public conference each year offer settings in which to explore issues at the nexus of medicine and the humanities. Everyone. in the fall of 2006. Several physician writers have acknowledged that one career nurtures the other. SCCM. in my experience. The recent 36th Critical Care Conference of the Society of Critical Care Medicine (SCCM) stressed the importance of education. poetry.30 For the past 20 years.

more broadly.” Drawing on the humanities will not only be healing for the patient. Iowa: University of Iowa Press. Medicine and professionalism. despite the harried and hurried lives of physicians.136: 243–246. Rather. and that concern can be harnessed to make our patients advocates for medical professionalism. NY: Oxford University Press. Beyond the physician charter: reflections on medical professionalism. When patients—and. we can help establish and maintain several of Stevens’11 conditions for ethical practice. must it become a focus in the practice environment.355:1794–1799. 10 Bryan CS. reflected the ideals of medicine. J S C Med Assoc. Bryan CS. provided a forum to challenge the audience to consider the consequences of lack of access to care for underserved populations or those with mental illness. 9 American Board of Internal Medicine. conditions such as building trust.163:145–149. or participating creatively in improving the health care system. An internist might cite John Stone’s brief poem “Grief. abim. A rheumatologist might share Renoir’s struggle to cope with rheumatoid arthritis as a patient sees her own capabilities shrinking with the progressive gnarling of her hands. Many patients are concerned about the current state of health care in the United States. the putative loss of which many now bemoan. individually and as a profession. An oncologist could chat with a patient undergoing chemotherapy about the patient’s impressions of a recent symphony concert both attended. Acad Med. Acad Med. Learning objectives for medical student education— guidelines for medical schools. The developing physician— becoming a professional. 4 Barondess JA. Only if we physicians. 7 Stern DT. II. 2002. References 1 Swick HM. Medical professionalism and humanism have long been integral to the practice of medicine. but as individuals with broader interests and dimensions and concerns. Summing Up continue to be the focus of formal educational efforts in undergraduate and graduate medical education. Ann Intern Med.100:123–125. Using the humanities to show our own humanity. Report 1 of the Medical School Objectives Project. Iowa City. to give that patient some hope for the future. for so long. Recruiting patients as advocates does not mean whining about the frustrations we feel about contemporary practice—the constraints and restraints.75: 612–616. It is a challenge we should embrace willingly.74:13–18.Professionalism Using patients as advocates. Papadakis MA. Educating for Professionalism. too. demonstrate high standards of professionalism and humanism will we be able to reassert the moral core of medicine and restore the trust that is at the heart of the patient–physician relationship. they are drawn from actual incidents. but coming to an understanding with people is hard. the communities in which we practice—see that we are willing to take leadership positions based on medicine’s values and moral foundation. in part because both reflect a moral imperative to serve. Project Professionalism. insisting on high standards of care. hence. Perspect Biol Med. 11 / November 2007 . as members of a profession. We can. Vol. Mt Sinai J Med. then those of us who are physicians must. 82. they will be more likely to support our profession’s efforts to improve health care by. 2 Medical Professionalism Project. and hence encourage the patient’s continuing social engagement during a difficult time. No. for example.69: 357–362. An ophthalmologist could tell a patient with progressive and irreversible vision loss about Rembrandt’s decreasing vision and its influence on his later paintings. The specific vignettes will necessarily depend on an individual physician’s interests. 2003. openly stress the importance of the profession’s values and the erosion of those values in the current environments of health care. Doing so reveals us not as technicians or scientists. Available at: (http://www. In doing so. 2000. individually and collectively. we can engage patients by consciously exemplifying our own professionalism. whenever appropriate.49: 263–275. Taking Missoula’s Pulse. A medicine residency clerkship director could echo Franz Kafka’s34 (p152) observation in “A Country Doctor” that “to write prescriptions is easy. 2000.pdf). There are many opportunities to foster professionalism and humanism in a busy practice environment. Creating a Culture of Humanism in Medical Education. One size does not fit all. but it will also enrich the physician’s own sense of satisfaction with practice. Continuing to foster professionalism outside the academic health center is critical to efforts to rebuild the traditional values of medicine. 2004. 2006. If the medical profession is to recapture and preserve the rich tapestry of professionalism and humanism that have. Arch Int Med. 6 Wear D. Accessed July 9. strive to express these qualities not only in clinical settings but also in the other communities we serve. N Engl J Med. Practicing physicians can use simple vignettes drawn from the humanities (broadly defined) to help explain otherwise difficult issues.” or suggest Mozart’s Requiem to comfort a grief-stricken family. improving access to care and ensuring conditions of social justice in medical practice. For example. Most of the following examples are not hypothetical or imaginary. ed. Bickel J. 2006. the IMH conference mentioned earlier. 5 The Medical School Objectives Writing Group. the hurdles and the stumbling blocks that interfere with our ability to care.org/pdf/profess. Longo LD. Themes in the history of medical professionalism. A family practitioner might help explain to third-year medical students the complex emotions evoked by patients by giving them a copy of “Case History” or “The Doctor” by Dannie Abse. so. Medical professionalism in the new millennium: a physician charter. Toward a normative definition of medical professionalism. 2007. New York. 3 Swick HM. Although professionalism must 1026 Academic Medicine. 2006. and they will continue to shape practice in the 21st century. 11 Stevens RA. Measuring Medical Professionalism. Our professionalism as physicians can also be exemplified by sharing with patients our own humanity and. We can work to ensure that every patient is treated with dignity and respect. our own vulnerability. 8 Stern DT. Advancing medical professionalism. eds. 2002. A neurologist might use Abse’s “The Stethoscope” during a white coat ceremony to convey to entering medical students the awesome privilege of being a physician. 1999.

Available at: (http://www. Need humanities be so useless? Justifying the place and role of humanities as a critical resource for performance and practice. New York. Association of American Medical Colleges (AAMC) Reporter. 82. 13 Miles SH. Ind: University of Notre Dame Press.library. 2004. Rafael Campo Campo R. 24 Swick HM. Chicago. 1991:9. The path to professionalism: cultivating humanistic values and attitudes in residency training. Kohatsu ND. 2004. The Good Doctor. In contrast to the rather dark. 1999. 25 Cruess SR. Noffke R. 30 Swick HM. 2006. 2006.69:378–384. Appendix Selected Works by Physician Authors That Convey the Values of Humanism and Professionalism Note: This very brief. Notre Dame. 15 Lasagna L. 1999. In: Temkin O. The Gold Humanism Honor Society. 1999. Ten patients and Another. Anton Chekhov Chekhov A. 31 Edgar A. 1889. A Force for Humanism in Medicine. 2007. Acad Med.73:751–755. Niki H. NY: The Modern Library. Susan Mates Mates S. ed. 34 Kafka FA.” Acad Med. 2003. et al. Suchman AL. 33 Chekhov A.org/ ethics/oaths. Frankel RM. 28 Osler W. 1952:148 –156. No. Accessed July 9. Mt Sinai J Med. Temkin LC.353:2673–2682. with no pretense to literary analysis. BMJ. In: What the Body Told. Acad Med. Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Cruess RL. Beckman HB.75:489– 495. the story “The Good Doctor” addresses gender roles in medicine and the complex emotional and psychological issues sometimes embedded in those roles. In: Hinohara S. Clin Anat. 14 The Prayer of Maimonides. 16 Markakis KM. 26 Papadakis MA. Objet d’art. A modern Hippocratic oath. Viewpoint: trends and transitions in the medical humanities. Accessed July 9. NY: Oxford University Press.mainehumanities. Disciplinary action by medical boards and prior behavior in medical school. University of Montana and St. In this volume. In: Wilkins R. Dee Publishers. NJ: Princeton University Press. Banach MA. Iowa: University of Iowa Press. Academic Medicine. 1994. 21 Green TF. Acad Med. Pattison S. 29:7–13. Acad Med. Gold Foundation. and interpretation. the story “Laundry” evokes the multiple. Ill: Ivan R. Teherani A. Iowa City. 22 Brint S.dal.78:1064.32:92–98.htm). 2005. conflicting demands of balancing professional with personal life.aapsonline. 11 / November 2007 1027 . Ancient Medicine: Selected Papers of Ludwig Edelstein. 32 Maine Humanities Council Web site. 1997. In an Age of Experts: The Changing Role of Professionals in Politics and Public Life. The Doctor’s Quotation Book. 2007.html). Durham. this is a lighthearted look at a doctor’s discomfort with a patient’s inappropriate expression of gratitude. profession and the virtues of the good physician.ca/kellogg/Bioethics/ codes/maimonides. Medical professionalism and the clinical anatomist. 1998. In: Pilcher H. 1967:2– 63. Hodgson CS. Professionalism must be taught. Chekhov: The Comic Stories. and clinical practice with research. Md: Johns Hopkins University Press. Professionalism. Princeton. pessimistic mood of many Chekhov stories. 2001:251–274. Available at: (http://www.79:244–249. New York. Teherani A.Professionalism 12 Edelstein L. Voices: The Educational Formation of Conscience. 2002. 27 Papadakis MA. 2002. 20 Wear D. 1996. eds. 23 Sullivan WM. What is left of professionalism after managed care? Hastings Cent Rep. J Med Ethics Med Humanit. Academic medicine must deal with the clash of business and professional values. Country doctor. Patrick Hospital and Health Sciences Center: Institute of Medicine and Humanities. eds. The case histories of 11 patients are related in language that slowly evolves from the medical to the lyrical. revealing the narrator’s own humanity. 29 Swick HM. 19 The Arnold P. 2000. Baltimore. NY: Barnes and Noble Books. New York. NC: Duke University Press. 17 Pellegrino ED. very personal list only hints at the numerous works by these and other writers that reveal the human dimensions of the practice of medicine. Gold Foundation. The master-word in medicine. Accessed July 9. NC: Duke University Press. Durham. 2007. 77:489–495. The Hippocratic Oath and the Ethics of Medicine. Letter dated October 11. N Engl J Med.htm#lasagna). 2006:3.19:393– 402. translation. Evaluating physicians’s professionalism and humanism: the case for humanism “connoisseurs. 18 Misch DA. 1994. with Commentary and Annotations. October 26. The Hippocratic oath: Text. NJ: The Arnold P. In: Selected Stories of Franz Kafka. 2005. org/programs/litandmed/index. Englewood Cliffs. Vol. In the same volume. Osler’s “A Way of Life” and Other Addresses. Available at: (http://www.315:1674–1677. The annotations are meant simply to provoke curiosity.

NY: Simon and Schuster. 1998. The Doctor Stories. Epiphany. and the reluctance that physicians sometimes feel in doing so. Raising the Dead. Baton Rouge.” for example. NY: New Directions Books. Selzer R. “Old Doc Rivers” challenges the reader to think about the impaired physician and the responsibility of professional colleagues to address the problem. sometimes difficult relationship between a crusty older physician and a patient whose experiences with racism and injustice slowly emerge over the course of numerous visits. In: The Doctor Stories.Professionalism Ferrol Sams Sams F. challenge us to think about the experiences of the physician as a caring. La: Louisiana State University Press. provides a patient’s perspective on life-threatening illness and hospitalization while revealing patients’ often complex experiences with caregivers. New York. No. 1984. New York. New York. addresses the complex emotions associated with giving bad news. East Lansing. 1994. This novella tells of a long. Many poems in this collection deal with the experiences of physicians and other caregivers. Selzer R. Mich: Michigan State University Press. “Talking to the Family. NY: Penguin Books. empathic human being. Many of Selzer’s “doctor stories” offer powerful insights into the nature of healing. Selzer’s memoir. Compiled by Robert Coles. “Toenails” and “Imelda. Raising the Dead. William Carlos Williams Williams WC.” for example. NY: Picador USA. New York. as well as the consequences of a physician’s inappropriate emotional response to patients. In: Letters to a Young Doctor. Many of Williams’ “doctor stories” have become iconic examples used in medical education to provoke questions of medical ethics and physician responsibilities. 82. Music from Apartment 8. Imelda. 2001. 1982:66 – 69. John Stone Stone J. 1028 Academic Medicine. “The Use of Force” invites discussion of ethical responsibilities and limits. “Gaudeamus Igitur: A Valediction” celebrates the awesome privilege of caring for patients and the many uncertainties inherent in clinical practice. In: New and Selected Poems. “Ancient Gentility” reveals the rewards and satisfaction of compassionate practice. Vol. Richard Selzer Selzer R. 11 / November 2007 . Toenails. 2004.

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