American College of Physicians: Internal Medicine — Doctors for Adults ®

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From 'Marcus Welby' to ‘ER’: Is medicine losing professionalism?

From the June ACP Observer, copyright © 2006 by the American College of Physicians.

PHILADELPHIA—As a sign of what’s wrong with professionalism today, Annual Session’s Keynote speaker considered the changing media images of physicians over the past 40-plus years. What does it say about the profession that television’s prime-time favorites have gone from the kindly and trusted "Marcus Welby, MD," to the self-absorbed stars of "House" and "ER?"


T. Jock Murray, MACP



These and other popular dramas portray physicians as “moody, rude, argumentative, uncooperative and disrespectful,” said T. Jock Murray, MACP, former dean of Dalhousie Medical School in Halifax, Nova Scotia, and professor emeritus of medicine (neurology).

In real life, such characters “would be the subject of official complaints and trashed in student and trainee evaluations,” he said. But while TV shows may exaggerate for dramatic effect, they are symptomatic of a general erosion of professionalism and a growing public cynicism about the profession.

“It reflects a public perception that professionalism, if not terminally ill, is sadly in need of medical attention,” he said.

That atmosphere calls for a new focus on professionalism’s three core principles: competency, the primacy of patient welfare and social justice. Professionalism is not an attempt to protect physicians' power and status, he noted, but a call to practice medicine in patients' best interests.

That’s not easy in an environment increasingly controlled by business interests. While it’s possible for business and medicine to work together, he said, it’s also important to recognize them as two separate spheres with different ethical systems. Just as physicians will never change industry ethics, business should not try to make medicine conform to a business model.

But professionalism cannot thrive unless physicians learn its underlying concepts and defend them, said Dr. Murray. While the College and others have come out with new definitions of professionalism, individual physicians must be as conversant with those principles as they are with diseases and conditions.

“We must be conscious," he said, "that every day, every moment, we are role models for future physicians and for what professionalism is all about.”

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