In American football parlance, "When the going gets tough, the tough get going."

Into year two of the COVID-19 pandemic, I reflect on the age-old issue of whether medicine functions primarily as a for-profit business or a service profession.

Medicine has always been both. Even Chaucer and George Bernard Shaw have written about it.

When I became a medical doctor in 1957, American medicine was primarily a service profession. However, after Medicare money became available in the mid-1960s, the business elements of the industry responded by growing. In the 1980s and 1990s, there was so much money to be had in the system that business interests came to predominate. Then the 21st century rolled around and the medical business roared.

But now, as we deal with a punishing pandemic and a severe recession, I wonder: Is medicine a profession or a business?

At its center, medicine is a moral enterprise, grounded in a covenant of trust. Medical educator Christine Cassel, MD, who has been widely cited for her remarks on medical ethics and professional care, said some of the distinguishing characteristics of a true medical professional are:

  1. Self-governance individually and as a group

  2. Service to the poor without expectation of compensation

  3. Delivering quality

  4. Not ripping people off

  5. High level of learning

  6. Autonomy of activity-earned autonomy

  7. Altruism

  8. Self-sacrifice

  9. Heroism as needed

  10. Ethical practice with public accountability

Famed medical ethicist Edmund Pellegrino, MD, stated in the AMA Journal of Ethics that "at some point in the professional relationship, when a difficult decision is to be made, you can depend on the true professional to efface his own self-interest."

As an 87-year-old physician sheltering at home during a pandemic, I neither participate in direct patient care nor see it firsthand. But modern mass media with its rapid dissemination of information has revealed that medical professionalism is alive and flourishing.

The price is high. Kaiser Health News and The Guardian are keeping a running tally of American healthcare workers who died "in the line of duty." The number exceeds 3000 as I write this article. Medscape keeps an international list of more than 1800 healthcare workers who have died of COVID-19 to date. So, we can tick off those 10 characteristics on Dr Cassel's list, especially numbers 2, 7, 8, and 9.

Meanwhile, the Association of American Medical Colleges reported an 18% increase in applicants for medical school during the pandemic. A year earlier, before the COVID-19 pandemic, there was a 0.6% drop in medical school applicants. These students are not running away in fear but are running forward in hope of helping. The future of medical professionalism that is in the hands of new bright-eyed and caring medical students seems safe indeed.

Greater love hath no man than this, that a man lay down his life for a friend. (John 15:13)

That's my opinion. I'm Dr George Lundberg, at large at Medscape.

George Lundberg, MD, is sheltering in place without access to his usual video studio. He is contributing editor at Cancer Commons and a clinical professor of pathology at Northwestern University. Previously, he served as editor-in-chief of JAMA (including 10 specialty journals), American Medical News, and Medscape.

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