In response to our president’s “Thoughts on professionalism” in the June issue (BCMJ 2016;58:247), I would like to add comments pertaining to his third tenet of our profession’s longstanding tradition—the value and merit of the social contract.

This longstanding tradition of a historically great and independent profession predates this country’s tiny historical anomaly of forced and unconstitutional social contracts—a contract that is with the state rather than with the patient, contrary to our Hippocratic Oath. Forced because we have a single payer that has legislated a monopoly, and because doctors must travel abroad to change their employers. Unconstitutional because it is a rationing monopoly, at least hurting patients in need.

The issue has become far more concerning recently for patients and physicians alike because the topic of physician-assisted death now also raises the uncomfortable question of whether physicians have finally become de facto agents of the state in this country.

Since professionalism is rather defined by skills, good judgment, and polite behavior that is expected from a person who is trained to do a job well, we should ask ourselves: where has our collective independence of thought and actions necessary to support good judgment gone lately? And will our patients be better off for its apparent absence?

Advocacy for our patients should be the real cornerstone of our profession, and it requires independence. Fighting internal and external factors that degrade our ability to advocate and care for patients and reverting the erosion of our profession is the ultimate healing goal for the profession itself.

This social contract that imposed itself slowly across several generations, by misrepresenting the original aim of Tommy Douglas, can only be seen as a clumsy ideological vestige of the past. It interferes with our primary commitment: our patients.

Dr Ruddiman, what we are fortunate to have is not that social contract but a direct contract with our patients, and having had an opportunity to acquire an amazing education (rapidly paid back with income tax), lifesaving skills in a very rewarding profession—an old one indeed—all these transcending ideology, generations, postal codes, and bureaucrats. That should be the foundation of our independence.

Our problem is then that we, as a profession, no longer believe that we belong to a great independent profession; rather, we subject ourselves to whatever master of the day is willing to pay us. Mercenaries, agents of the state, whatever you may want to call us, we are no longer the healers of the Hippocratic Oath. The legacy will not be excellent 21st-century medical care and we will be remembered as enablers who replaced the Hippocratic Oath with an oath (little “o”) to the state. And isn’t that what we do not want to become!
—J.N. Mahy, MD, FRCSC, FACS
Burnaby