A brief history of medical professionalism-and why professionalism matters

Much has been written in recent years about medical professionalism. Its definition seems to evolve constantly, but its importance in an ever-changing medical climate becomes more and more apparent. This review traces the historical underpinnings of current medical professionalism and reasserts its necessity for the continued vitality of medicine.

Early medical ideals

It is not known how valued these ideas were at the time they were written, but the Roman physician Scribonius Largus affirmed their importance about 500 years later. A firm believer in the fiduciary responsibility inherent in medicine and outlined in the Hippocratic Oath, Largus taught these principles as he traveled with the Roman army throughout the empire.²

These ideals were not unique to the Western world. The Charaka Samhita, an ancient Indian code of conduct, states that "he who practices not for money nor caprice but out of compassion for living beings, is the best among physicians." Similarly, the Chinese ethicist Sun Simiao, writing in the seventh century, stressed compassion, piety, equal treatment of patients, and the avoidance of greed among physicians.³

From personal oath to professional standards

During the Middle Ages, religion dominated medical practice, but with the Renaissance came renewed interest in classical writings, particularly the Hippocratic Corpus. The Hippocratic Oath (changed to accord with Christian beliefs) became a regular attestation in European medical schools in combination with gentlemanly codes of honor. These codes of honor were the standards that guaranteed moral integrity and professional conduct; they were, by definition, based on the individual and not the profession as a whole. Therein lay their inherent weakness-one that came to light in the late 1700s in Manchester, England.

Medical Ethics was revolutionary in that it created a standard for professional conduct based not on individual integrity but the integrity of the profession itself. It replaced the subjective language of oath with standards of conduct, which Percival outlined as duties. These duties were justified by the medical profession's collective responsibility to care for the sick and encompassed everything from etiquette to basic hospital procedure. Percival urged physicians to "study also, in their deportment, so to unite tenderness with steadiness, and condescension with authority, as to inspire the minds of their patients with gratitude, respect, and confidence."⁴