Medical professionalism project

To the Editor: You recently lent your support to the "physicians' charter" produced by the members of the Medical Professionalism Project.1

According to the document, the charter is part of the process of reforming healthcare systems. If the authors are hoping to use this document to change the way medicine is delivered, they should be prepared for criticism.

The simplest criticism is that they present no evidence. Sweeping statements are made, without supporting documentation, about the potential for dishonest behaviour by physicians. Even broader generalisations are made about the appropriate way to run healthcare, again without evidence.

The authors state that "physicians should never exploit patients for . . . personal financial gain or other private purpose". While the word "exploit" has a pejorative flavour, it is reasonable for doctors to be paid for what they do. The "sackcloth and ashes" version of medical practice appeals to a small minority.

They then move deeper into socialist territory: "Medical professionalism demands that the objective of all healthcare systems be the availability of a uniform and adequate standard of care." But the standard of healthcare can never be uniform, and vigorous attempts to make it so could conceivably undermine its quality.

"Political correctness" proceeds apace. "A commitment to equity entails the promotion of public health and preventive medicine . . .". Why, for goodness' sake? Preventive medicine is not always cost effective.

The authors then propose their own version of health economics. In their view "the provision of unnecessary services not only exposes patients to avoidable harm and expense but also diminishes the resources available for others". This is not necessarily so. Some services will turn out to be superfluous. There are other areas of extravagance in our society (eg, fast cars, big houses, and all restaurants), but they still make an important contribution to the economy.

Growth in healthcare expenditure expands the whole economy, and I am not aware of any evidence that spending in one area of healthcare necessarily deprives others. It could well be the reverse.

Politically correct attitudes are widespread in the medical community,2 but should not be imposed on others, as the Editor was perhaps suggesting.