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"
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
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.