Managed Care And The Imperative For A New Professional Ethic

PROLOGUE: In his landmark work, The Structure of Scientific Revolutions, Thomas Kuhn put his finger on the notion that science was a social enterprise and that scientific innovations were best thought of as responses to cultural imperatives rather than ordered steps in a ceaseless march toward the “truth.” Along the way, Kuhn observed that prevailing notions in science gave way to new ones only after young scientists, acutely aware of the inadequacies of the outdated theories of their mentors, were able to persuade enough of their peers that there was something drastically wrong with the established order. Thus was born the now hackneyed term “paradigm shift.” In this paper David Mechanic argues similarly that medicine is being pulled in one direction by members of the old guard, who rail against managed care and its effects on traditional notions of medical professionalism, and in another by broader trends that call out for a new professional ethic that takes account of a broader set of responsibilities for physicians. These emerging demands on physicians will require fresh thinking. Mechanic has been studying medical organization for more than three decades and has witnessed a number of transformations in the U.S. health care system. During this time his work has appeared regularly in a number of esteemed journals. He is the René Dubos University Professor of Behavioral Sciences and director of the Institute for Health, Health Care Policy, and Aging Research at Rutgers University. ABSTRACT: Physicians complain about the growth of managed care structures and strategies and their effects on treatment autonomy and medical professionalism. Organizational changes and a competitive marketplace make the traditional view less relevant today. New concepts of professionalism are needed that recognize constraints and include patient advocacy within a framework of procedural justice, responsibility for population health, new patient partnerships, and participation in an evidence-based culture. Such changes require more focused efforts in medical education to support the new professionalism.