In 2002, the American Board of Internal Medicine Foundation, the American College of Physicians Foundation, and the European Federation of Internal Medicine published A Physician Charter: Medical Professionalism in the New Millennium, which articulated a set of professional responsibilities that physicians were considered honor-bound to fulfill.1,2 On close reading of the charter, it is clear that the institutional and organizational settings of contemporary medical practice pose significant impediments to achieving several of the responsibilities to be assumed by physicians. Moreover, many of those impediments are so deeply imbedded in all health care systems that they are beyond the control of physicians. Only those in a position to effect system-wide changes (eg, elected officials, ministers of heath) can eliminate these structural impediments. Consequently, if the public is to continue to enjoy the unique benefits that medical professionalism can offer, some form of a functional alliance between the medical profession and society (medical-societal alliance) is necessary.
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