ABSTRACT
This chapter identifies the dynamics and consequences of a curious taboo in official American health culture: namely, a prohibition upon allowing physicians to appear concerned with financial matters within the physician role. It describes as a taboo represents an irreconcilable conflict between “caring” values and “business” values in medicine. This conflict has defied solution within the culture of medicine despite continuing attempts to resolve it. Historically, in American medicine, money has long had a bad name. It is not my intention to polish money’s tarnished image or to cleanse its soiled reputation. American medicine characterizes itself according to many diverse, even competing images: a biomedical science, a form of service, a high-technology trade, a helping profession, an intellectual pursuit, and a clinical practice. Medicine must labor overtime to disavow those sins of avarice and gluttony from which it cannot escape accusation and condemnation.
