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Clin Orthop Relat Res. 2006 Aug;449:170-6.

Professionalism and medicine's social contract with society.

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Centre for Medical Education, McGill University, Montreal, Quebec, Canada.


Medicine's relationship with society has been described as a social contract: an "as if" contract with obligations and expectations on the part of both society and medicine, "each of the other". The term is often used without elaboration by those writing on professionalism in medicine. Based on the literature, society's expectations of medicine are: the services of the healer, assured competence, altruistic service, morality and integrity, accountability, transparency, objective advice, and promotion of the public good. Medicine's expectations of society are: trust, autonomy, self-regulation, a health care system that is value-driven and adequately funded, participation in public policy, shared responsibility for health, a monopoly, and both non-financial and financial rewards. The recognition of these expectations is important as they serve as the basis of a series of obligations which are necessary for the maintenance of medicine as a profession. Mutual trust and reasonable demands are required of both parties to the contract.

[Indexed for MEDLINE]

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