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

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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.

Table 1.

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

Patients/Public Expectations of Medicine	Medicine’s Expectations of Patients/Public
Fulfill the role of the healer	Trust
Assured competence of physicians	Autonomy sufficient to exercise judgment
Timely access to competent care	Role in public policy in health
Altruistic service	Shared responsibility for health
Morality, integrity, honesty	Self regulation
Trustworthiness	Balanced lifestyle
Codes of ethics	Monopoly
Accountability: performance, productivity, cost effectiveness	Rewards: non-financial
Transparency in decision making and administration	Respect
Respect for patient dignity and autonomy	Status
Source of objective advice on health matters	Rewards: Financial
Team health care
Promotion of the public good