Intravesical bacille Calmette-Guerin in patients with asymptomatic bacteriuria.

providing emergent care, we hope to raise the collective responsiveness to the needs of the public. Mr Fesnak and Dr Rajput express concerns about physicians’ professional responsibility to promote fair and ethical stewardship of health care resources. Physicians may be uncomfortable with their role when they define their professional responsibilities from the narrow perspective of the physician “at the bedside” and only as an individual, direct care provider. Taking a systems view of professionalism offers a more expansive understanding of how physicians can influence and promote the fair and ethical stewardship of health care resources. Physicians can pursue a range of activities via professional organizations and advocacy efforts to fulfill their responsibility to advance fair and ethical stewardship of health care resources. We agree that this is a shared responsibility that must be carried out in collaboration with payers, policy makers, and the public. But we also reaffirm the critical role of the medical profession in this important work. As the United States continues to confront unsustainable growth of health care spending, it is imperative that physicians engage in the collective effort to ensure that limited resources are effectively deployed to optimize health and health care for all residents. Finally, we agree with Dr Gale that key Supreme Court decisions pertaining to professionalism provide important context for understanding professionalism in the current environment. However, we interpret these rulings as largely consistent with the “systems view” of professionalism, recognizing that medical care is delivered in the context of the organizational and policy environment. We do not view these decisions as limiting physicians’ professional responsibilities as individual clinicians or as members of the profession as a whole. Further, the legacy of court decisions in this area does not obviate physicians’ collective responsibility to continue to reflect on and more clearly articulate the profession’s expectations of physicians in service of society.