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Research ArticleArticle

Professionalism, Communities of Practice, and Medicine’s Social Contract

Richard L. Cruess and Sylvia R. Cruess
The Journal of the American Board of Family Medicine September 2020, 33 (Supplement) S50-S56; DOI: https://doi.org/10.3122/jabfm.2020.S1.190417
Richard L. Cruess
the Institute for Health Sciences Education, Lady Meredith House, McGill University, Quebec, Canada.
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Sylvia R. Cruess
the Institute for Health Sciences Education, Lady Meredith House, McGill University, Quebec, Canada.
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    Figure 1.

    The attributes traditionally associated with the healer are shown in the left hand circle and those with the professional on the right. As can be seen, there are attributes unique to each role. Those shared by both are found in the large area of overlap of the circles. This list of attributes is drawn from the literature on healing and professionalism.

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    Figure 2.

    A schematic representation of medicine’s social contract with society. Neither medicine nor society are monolithic, with each arriving at a negotiating position after an internal discourse between the various internal stakeholders.

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    Table 1.

    The Expectations of the Two Major Parties Involved in Medicine's Social Contract

    Patients/Public Expectations of MedicineMedicine’s Expectations of Patients/Public
    Fulfill the role of the healerTrust
    Assured competence of physiciansAutonomy sufficient to exercise judgment
    Timely access to competent careRole in public policy in health
    Altruistic serviceShared responsibility for health
    Morality, integrity, honestySelf regulation
    TrustworthinessBalanced lifestyle
    Codes of ethicsMonopoly
    Accountability: performance, productivity, cost effectivenessRewards: non-financial
    Transparency in decision making and administrationRespect
    Respect for patient dignity and autonomyStatus
    Source of objective advice on health mattersRewards: Financial
    Team health care
    Promotion of the public good
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The Journal of the American Board of Family   Medicine: 33 (Supplement)
The Journal of the American Board of Family Medicine
Vol. 33, Issue Supplement
September-October 2020
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Professionalism, Communities of Practice, and Medicine’s Social Contract
Richard L. Cruess, Sylvia R. Cruess
The Journal of the American Board of Family Medicine Sep 2020, 33 (Supplement) S50-S56; DOI: 10.3122/jabfm.2020.S1.190417

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Professionalism, Communities of Practice, and Medicine’s Social Contract
Richard L. Cruess, Sylvia R. Cruess
The Journal of the American Board of Family Medicine Sep 2020, 33 (Supplement) S50-S56; DOI: 10.3122/jabfm.2020.S1.190417
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  • Article
    • Abstract
    • Introduction
    • The Healer and the Professional
    • The Social Contract
    • Medicine’s Community of Practice and Social Negotiations
    • What Principles Should Guide Social Negotiations?
    • Notes
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Keywords

  • Contracts
  • Delivery of Health Care
  • Health Policy
  • Medical Education
  • Professionalism
  • Social Justice

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