What is the difference between a profession and a business?
The line between a business and a profession is not entirely clear, since professionals may engage in business and make a living by it. However, one crucial difference distinguishes them: professionals have a fiduciary duty toward those they serve. This means that professionals have a particularly stringent duty to assure that their decisions and actions serve the welfare of their patients or clients, even at some cost to themselves. Professions have codes of ethics which specify the obligations arising from this fiduciary duty. Ethical problems often occur when there appears to be a conflict between these obligations or between fiduciary duties and personal goals.
What are the recognized obligations and values of a professional physician?
Professionalism requires that the practitioner strive for excellence in the following areas, which should be modeled by mentors and teachers and become part of the attitudes, behaviors, and skills integral to patient care:
• Altruism: A physician is obligated to attend to the best interest of patients, rather than self-interest.
• Accountability: Physicians are accountable to their patients, to society on issues of public health, and to their profession.
• Excellence: Physicians are obligated to make a commitment to life-long learning.
• Duty: A physician should be available and responsive when “on call,” accepting a commitment to service within the profession and the community.
• Honor and integrity: Physicians should be committed to being fair, truthful and straightforward in their interactions with patients and the profession.
• Respect for others: A physician should demonstrate respect for patients and their families, other physicians and team members, medical students, residents and fellows.
These values should provide guidance for promoting professional behavior and for making difficult ethical decisions.
A Physician Charter: Medical Professionalism in the New Millennium was issued jointly by the American Board of Internal Medicine, the American College of Physicians and the European Federation of Internal Medicine in 2002. Subsequently, 90 professional associations, including most of the specialty and subspecialty groups in American medicine have endorsed the Charter. The fundamental principles of professionalism are stated as (1) the primacy of patient welfare; (2) patient autonomy; (3) social justice. Professional responsibilities that follow from these principles are commitment to competence, to honesty with patients, to confidentiality, to appropriate relationship with patients, to improving quality of care, to improving access to care, to a just distribution of finite resource, to scientific knowledge, to maintaining trust by managing conflicts of interests and to professional responsibilities.
Is professionalism compatible with the restrictions sometimes placed on physician’s judgments in managed care?

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