The Future of Medical Practice

Prologue: In the six years that Arnold Relman has served as editor of The New England Journal of Medicine , this weekly publication has devoted evermore attention and space to publishing a range of views on health policy issues. The emphasis is in keeping with Relman s penchant to inform his largely physician audience on issues beyond their everyday clinical activities. Obviously, though, the central purpose of the journal is to keep practitioners on the cutting edge of change in clinical medicine. Relman, a philosopher-physician who brings to his editorship a thirty-year perspective as a nephrologist, medical educator, and clinical researcher, often contributes to this dialogue, offering opinions on subjects ranging from nuclear war and physicians to treatment of end-stage renal disease to Moscow in January and more. But in no instance has Relman devoted more space or personal fervor than he did in the fall of 1980 when he wrote “The New Medical-Industrial Complex,” an article that remains as controversial today as the day it was published. Relman's focus is the physician and his (and increasingly) her role in society. Relman believes to the core of his professional being that medical practice has a crucial moral component: the commitment of the doctor to the patient, to put the patient's interest above his own, and always to do what is in the patient's best interest to the best of his ability. He said in an interview not long ago: “When doctors begin seeing themselves as businessmen, simply selling a highly technical service, that will be the beginning of the end for the profession. “In this article, adapted from the Merrimon Lecture which Relman delivered at the University of North Carolina last October, he urges the medical profession to recognize this danger and address it. Relman asks not that society change, but that doctors be steadfast in maintaining “responsible professionalism.” He has delivered this plea to the American Medical Associations Board of Trustees and in other bastions of medical influence. Coming as it does from the most powerful man in medical publishing today, it's not a message that the profession can afford to take lightly.