The social-contract model of professionalism: baby or bath water?

the physician role as a base. There might be perceived sexual gain or exploitation involved (about two-thirds of boundary cases have been such). But it might also involve perceived personal or ªnancial exploitation. (In the cases of boundary violations, we carefully use the word perceived because this is so often contended.) The second range of ethical misconduct is self-serving ªnancial gain or violations of the professional obligation to maintain a ªduciary role with respect to the public (or healthcare insurance) purse. This include behaviors or indications of behavior that take place both within and outside the practice of medicine. Such obvious infractions as up-coding, bundling, and conºict-of-interest referrals, most of which constitute criminal fraud, are included in this category. So also are offenses that violate normal civic responsibilities such as reporting income, paying debts, and safeguarding pension funds. The third range—misrepresentations—is most common in the context of licensing-board and residency-training applications. Failure to account for periods of time in one's curriculum vitae, exaggerating the content of training activities, and omitting failures or incomplete professional experiences are some of the common application based misrepresentations. They are no less a violation of professional ethics than compared with overstating competencies, claiming training that was not completed, practicing beyond jurisdictions, and other more " serious " infractions. Several observations can be made regarding this juxta-position of the abstract professionalism movement and the concrete infractions brieºy cited above. First, the individuals who have committed these infractions are able to recite the virtues of medical professionalism in the blink of an eye. Second, all of these charges of misconduct are brought by, or in the name of, the public—that is, pa-tients—who have been subjected to the unethical practices or behavior of these physicians. The relationship is not distant , and the harm done to patients by a member of the profession is concrete and often painfully speciªc. Third, the training that these professionals bring to their practice has not included any of these possibilities. Basic as they might seem to the academic, the application of virtues that might forestall unethical conduct is not addressed. Fourth and most important, ample case material exists for use in student and resident curricula. These are cases of misconduct for which students and residents have no imagination, much less experience or expectation. Empirically , these cases involve the violation neither of broad nor of particularly nuanced professional virtues. Perhaps orienting curricula …