Case example

Dr. George Gayle has just completed the final stage in his formal medical training, a fellowship in medical oncology, and has joined a local multispecialty medical practice. He is a devoutly religious man and is a leading member of a large Christian congregation. Because his religious faith is such a central part of his life, Dr. Gayle would like to incorporate his spiritual beliefs into his professional practice.

Dr. Gayle informs his physician colleagues that he intends to address spiritual issues with his patients in several ways, including asking all of his patients about their own spiritual beliefs and practices, inviting patients to pray for healing with him, encouraging patients to take advantage of the health benefits of prayer and of other religious practices, inviting patients to visit the Sunday school course he teaches, and helping patients with serious illness understand that there is meaning in life and hope for the future. May he engage in these activities with his patients?

Over the past two decades, professionalism has become a major topic of discussion in medicine and health care. Commentators warn that the increasing commercialization and bureaucratization of health care is undermining the professionalism of physicians and other health care professionals. In response, professional associations have adopted formal statements pledging support for principles of professionalism, and professional schools have expanded professionalism instruction for their students. This chapter will examine the concept of professionalism and consider its moral significance in health care. It will then focus on one specific application of the concept of professionalism, namely, the identification and enforcement of professional boundaries.

Conceptual issues

Despite general agreement about the importance of professionalism in health care, there is considerably less consensus on the meaning of this term. In its most general sense, ‘professionalism’ is defined as “the conduct, aims, or qualities that characterize or mark a profession or a professional person.” As this definition indicates, understanding what is meant by professionalism requires a prior understanding of the concepts of a profession and a professional. But these latter concepts have many meanings, and they are associated with many kinds of “conduct, aims, and qualities.”