I offer this comment as an amendment to the letter of Dr. Julian Bravo in the November 17, 2006, issue in which he voiced his concern about the not infrequently encountered reference to "clients" in place of" patients."

I agree that it is important that we recognize, and are conscious of, how such word usage characterizes the content of and our disposition toward our medical activities. Dr. Bravo suggested that insurance companies make us see" clients" since the goal is to maximize profit instead of the well-being of human beings, the "patients."

I would expand this characterization by pointing out that there are at least three ways of practicing medicine (by which I mean all types of professional activities of physicians): as a vocation, a business, or a job. These may entail identical professional know-how in the technical sense, but differ in their humanistic and ethical underpinnings, that is, in the nature of the relationship with those whom our professional activities are supposed to benefit.

When practicing medicine as a vocation, the doctor-patient relationship is motivated by service to others. Practicing as a business means that in the businessman-consumer relationship the motivator is the physician's financial interest. When the practice of medicine is a job, the employee-client relationship depends on factors and considerations external to it. I have elaborated on these issues elsewhere, most recently in the April 2006, Southern Medical Journal.

I agree that external, business-motivated circumstances have impinged on how medicine has been practiced and perceived in recent decades. In my view, it has been a downhill course, and in the process our professional and moral integrity has also been damaged to the detriment of patients and of society as well. We have to acknowledge our responsibilities for the current predicament of our health care "system" and consider how to guide future physicians and society toward humanistic medicine that is practiced as a vocation and available to all.