Perspectives in biology and medicine
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Perspect. Biol. Med. · Jan 2008
Historical ArticleThe short history and tenuous future of medical professionalism: the erosion of medicine's social contract.
The profession of medicine is based on a shared set of tacit and explicit agreements about what patients, doctors, and society at large should be able to expect from each other, a social contract that defines the profession. Historically, the development of this set of agreements depended upon the creation of social organizations that could speak for the entire profession. Over the last several decades, however, the perceived need for these organizations, and especially the umbrella organization for the profession, the American Medical Association, has waned. ⋯ To address these problems, a renewed social contract is necessary. Although this renewed contract should be based on foundations similar to the original, it must directly confront such contemporary challenges as resource allocation and conflicts of interest. Equally as important, to reinvigorate our social contract more physicians will need to come to grips with a basic truth: to sustain professionalism we need a strong, unified professional association.
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The Internet is revolutionizing medical education and medical practice by enabling teachers and students to utilize and integrate many forms of data in ways that cannot be done via classic textbooks. In cardiovascular medicine, dynamic images are essential for understanding cardiac function, coronary anatomy, and myocardial perfusion, as well as for learning cardiovascular pathophysiology and the typical and atypical presentations of disease states. Cardiosource, an educational Web site developed by the American College of Cardiology, illustrates the ways in which the Internet is being used to improve medical education and practice.
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Empathy is a highly desirable trait in a physician, but the term means different things to different people. Rather than focus on empathy, it may be more fruitful to consider the individual ingredients of a successful patient-physician engagement: scientific competency, imagination (the basis of empathy), caring about the patient, attentive (nonjudgmental) listening to the person's story, and skill in rewriting the illness story. The cardinal skill, on a sound base of scientific competence, is imagination. A successful engagement has beneficial consequences for physicians as well as patients.
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We present the medical students' perspective on the hotly contested topic of professionalism in medical education and explore why students are often hostile to education in professionalism. We then suggest ways to improve professionalism education in the medical curriculum.