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II.2 Professionalism and Medicine's Social Contract--Richard L. Cruess and Sylvia R. Cruess
Pages 75-85

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From page 75...
... That depends on the views of the participants who represent numerous professions and perspectives. Will it be possible to develop a shared social contract with society for the next generation of health professionals?
From page 76...
... proposed that a "bargain" had been struck in which the medical profession preserved its autonomy and privileged position in return for supporting the new health care system. Following this, others have used the term "implicit bargain," particularly during recent years, because, they pointed out, the bargain appeared to have broken down.
From page 77...
... In placing health care in the context of the social contract, it can be located within what has been labeled a "macro" contract (Donaldson and Dunfee, 1999, 2002) , which includes all essential services required
From page 78...
... It appears to us that this latter approach better describes the reality of the relationship. It has the further advantage of allowing health care issues to be addressed in isolation from other issues in society within the context of the overall macro contract.
From page 79...
... Within the circle chosen to represent the medical profession are found a myriad of firmly held opinions, vested interests, and political orientations. Individual physicians often dis THE SOCIAL CONTRACT SOCIETY THE MEDICAL PROFESSION PaƟents SM Medicine's NALI ESSIO InsƟtuƟons PROF General Public ExpectaƟons ObligaƟons Government Individual PRO PoliƟcians Physicians FESS IONA LISM Civil Servants EXTERNAL INFLUENCES Managers Health Care System Public/Private Mix Regulatory Framework Media Commercial Sector Other Health Care Professions FIGURE II-4  A schematic representation of medicine's social contract with society.
From page 80...
... When one focuses on health care, citizens can be designated as patients and members of the general public. Obviously, members of the general public have a clear and personal interest in the relationship with the medical profession, because virtually every citizen will eventually need the services of the healer.
From page 81...
... . The nature of the national health care system is undoubtedly the most powerful.
From page 82...
... In Canada, where responsibility for health is a fiercely protected provincial jurisdiction, each province or territory has its own health care system which, while adhering to national standards, can accommodate differing regional needs (Marchildon, 2006)
From page 83...
... Patients' expectations of individual physicians and of medicine are well documented. They want accessible care within the context of a health care system that is value-laden, equitable, and adequately funded and staffed.
From page 84...
... and want the profession to practice team health care, expectations that have become much more important in recent times. It is interesting that the expectations of individual physicians and of medicine as a whole are rarely made explicit in a coherent fashion.
From page 85...
... An obvious recourse is to negotiate for a health care system that actually supports professional values, a direction that can benefit both medicine and society (Wynia et al., 1999; Sullivan, 2005; Cohen et al., 2007)


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