The Remains of the Profession, or What the Butler Knew
Authors: Ellen S. More
Journal: Annals of Internal Medicine (2001)

Medical Writings6 February 2001The Remains of the Profession, or What the Butler KnewEllen S. More, PhDEllen S. More, PhDDr. More: University of Texas Medical Branch; Galveston, TX 77555-1311Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-134-3-200102060-00030 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Forty percent to 50% of physicians today are salaried employees (1). The rapid transformation of the independent practitioner into the employee-practitioner has prompted widespread debate about the potential erosion of medical professionalism, especially physicians' autonomy and integrity (2-5). This essay was prompted by a rereading of The Remains of the Day(6), Kazuo Ishiguro's brilliant novel about an English butler's moral awakening, against the background of these concerns.Traditionally, professional autonomy was defined as control over work practices and values; in most discussions of the issue, this is still the sense in which the term is used. Authentic professional autonomy thus ...References1. Bodenheimer T. The American health care system: physicians and the changing medical marketplace. N Engl J Med. 1999;340:584-8. CrossrefMedlineGoogle Scholar2. Hall MA, Berenson RA. Ethical practice in managed care: a dose of realism. Ann Intern Med. 1998;128:395-402. LinkGoogle Scholar3. Kassirer JP. Managing care—should we adopt a new ethic? [Editorial]. N Engl J Med. 1998;339:397-8. CrossrefMedlineGoogle Scholar4. Cleaveland R. Correspondence: doctor discontent. N Engl J Med. 1998;339:1543-5. CrossrefMedlineGoogle Scholar5. 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More, PhDAffiliations: Dr. More: University of Texas Medical Branch; Galveston, TX 77555-1311Presented in preliminary form at the McGovern Symposium on Professional Values in the Art of Health Care Practice, Galveston, Texas, 6 March 1999.Acknowledgments: The author thanks Professors Michele Carter, Albert Jonsen, and Laurence McCullough for helpful comments.Corresponding Author: Ellen S. More, PhD, University of Texas Medical Branch, Galveston, TX 77555-1311. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byViewpoint: Are We Serious About Teaching Professionalism in Medicine? 6 February 2001Volume 134, Issue 3Page: 255-259KeywordsEmotionsExerciseHealth careHospital medicineMemoryMotivationPublic policySports and exercise medicineStrokeSurgeons ePublished: 6 February 2001 Issue Published: 6 February 2001 Copyright & PermissionsCopyright © 2001 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...