ISSUES IN medical professionalism, including its nature and applicability, are being discussed with increasing frequency by clinicians, educators, sociologists, legal scholars, and others1- 11 against a background of marked change in the structure and environment of medicine in the United States. Internally, a progressively deeper and broader science base has transformed and made more complex the task of the physician, has led to a more specialized and technology-intensive mode of practice, and has resulted in the emergence of prominent specialty interests focused in the various clinical societies. External to the profession, extraordinary rises in health care costs have resulted in striking changes in the terrain on which medicine is practiced. Powerful players, notably employers and government, concerned with cost management have catalyzed new arrangements in clinical care, resulting in derivative intrusions on the clinical autonomy of the individual physician, corporate ownership of health care systems, commodification of the clinical process,2,12 and severe fiscal pressures on hospitals, with only a transient impact on cost increases.
Thank you for submitting a comment on this article. It will be reviewed by JAMA Internal Medicine editors. You will be notified when your comment has been published. Comments should not exceed 500 words of text and 10 references.
Do not submit personal medical questions or information that could identify a specific patient, questions about a particular case, or general inquiries to an author. Only content that has not been published, posted, or submitted elsewhere should be submitted. By submitting this Comment, you and any coauthors transfer copyright to the journal if your Comment is posted.
* = Required Field
Disclosure of Any Conflicts of Interest*
Indicate all relevant conflicts of interest of each author below, including all relevant financial interests, activities, and relationships within the past 3 years including, but not limited to, employment, affiliation, grants or funding, consultancies, honoraria or payment, speakers’ bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued. If all authors have none, check "No potential conflicts or relevant financial interests" in the box below. Please also indicate any funding received in support of this work. The information will be posted with your response.
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 23
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
Care at the Close of Life: Evidence and Experience
All results at
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.