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Special Communication |

Physician-Citizens—Public Roles and Professional Obligations

Russell L. Gruen, MBBS; Steven D. Pearson, MD, MSc; Troyen A. Brennan, MD, JD, MPH
JAMA. 2004;291(1):94-98. doi:10.1001/jama.291.1.94.
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Although leaders and other commentators have called for the medical profession's greater engagement in improving systems of care and population health, neither medical education nor the practice environment has fostered such engagement. Missing have been a clear definition of physicians' public roles, reasonable limits to what can be expected, and familiarity with tasks that are compatible with busy medical practices. We address these issues by proposing a definition and a conceptual model of public roles that require evidence of disease causation and are guided by the feasibility and efficacy of physician involvement. We then frame a public agenda for individual physicians and physician organizations that focuses on advocacy and community participation. By doing so, we aim to stimulate dialogue about the appropriateness of such roles and promote physician engagement with pressing health issues in the public arena.

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Figure. Model of Physician Responsibility in Relation to Influences on Health
Graphic Jump Location
The ways in which socioeconomic factors influence individual patients' health are shown in expanding domains, depicting the proximity of each to physicians' core responsibility for patient care. Physicians have professional obligations to promote access to care and address socioeconomic factors that directly influence individuals' health (eg, smoking, road safety, interpersonal violence, housing conditions that cause disease), according to evidence of illness causation and feasibility of physician action. Aspirations for improving broader health determinants (eg, local or global disparities in income, education, or opportunity) are laudable, but physicians' responsibilities in these domains may not be sufficiently different from those of other citizens for them to be recognized as professional obligations. As evidence changes, however, issues may move from one domain to another.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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