ABSTRACT
The idea of physician professionalism dates back to the Hippocratic oath, which instructed physicians to practice medicine for “the benefit of patients and abstain from whatever is deleterious and mischievous” (Shortell, Waters, Clarke, &c Budetti, 1998). Patient trust in the physician-patient rela tionship is based on the idea that physicians have responsibility and control over medical decision making and that physicians prioritize the needs of patients over all other considerations (Mechanic & Schlesinger, 1996). In recent years, the issue of pro fessionalism among physicians has been the central focus of numerous national and international medical conferences, medical journal publications, and public initiatives by professional organizations (American Board of Internal Medicine Foundation, 2003). Concern by these groups over the effects of a changing U.S. health care delivery system on physicians’ primary dedication to patients has spawned a call for renewed commitment to the principles of the primacy of patient welfare, patient autonomy, and social welfare (ABIM Foundation, ACP-ASIM Foundation, & European Federation of Internal Medicine, 2002). In part, this professional ism “movement” has been motivated by perceived negative effects of the efforts by health care orga nizations to improve quality and decrease costs on the ability of physicians to serve as advocates for their patients (Shortell et al., 1998). In the current era in which competition between health care orga nizations is increasingly based on reducing inap propriate variations in care (Wennberg, 1998) and
improving quality of care and patient satisfaction (Enthoven & Vorhaus, 1997), the perceived conflict between the goals of physicians as professionals and organizational management efforts may help to explain why so many organizational attempts to change physician behavior meet with failure (Grimshaw et al., 2001).
