Moving beyond nostalgia and motives: Towards a complexity science view of medical professionalism

Abstract

Modern-day discourse on medical professionalism has largely been dominated by a "nostalgic" view, emphasizing individual motives and behaviors. Shaped by a defining conflict between commercialism and professionalism, this discourse has unfolded through a series of waves, the first four of which are discovery, definition, assessment, and institutionalization.They have unfolded in a series of highly interactive and overlapping sequences that extend into the present.The fifth wave-linking structure and agency-which is nascent, proposes to shift our focus on professionalism from changing individuals to modifying the underlying structural and environmental forces that shape social actors and actions.The sixth wave-complexity science-is more incubatory in nature and seeks to recast social actors, social structures, and environmental factors as interactive, adaptive, and interdependent.Moving towards such a framing is necessary if medicine is to effectively reestablish professionalism as a core principle. © 2008 by The Johns Hopkins University Press.