Vol.:(0123456789) Theoretical Medicine and Bioethics https://doi.org/10.1007/s11017-019-09492-x 1 3 Professing clinical medicine in an evolving health care network James A. Marcum 1 © Springer Nature B.V. 2019 Abstract For at least the past several decades, medicine has been embroiled in a crisis con- cerning the nature of its professionalism. The fundamental questions that drive this ongoing crisis are primarily three. First, what is the nature of medical professional- ism? Second, who are medical professionals? Third, what does medicine or these professionals profess or promise? In this paper, the professionalism crisis vis-à-vis these questions is examined and analyzed chiefy in terms of both Francis Peabody’s and Edmund Pellegrino’s writings. Based on their writings, I introduce a conceptual framework for professionalism to address the crisis. In addition, I contend that to address the professionalism crisis adequately, medicine’s position within an evolv- ing health care network must also be considered. To that end, I frst discuss the gen- esis of the crisis in terms of the Flexner Report and especially Peabody’s response to it. Next, I explore how the crisis intensifed during the twentieth century, par- ticularly in terms of medicine’s ultimate scientifcation and eventual commercializa- tion, and how Pellegrino reacted to this. I then propose a health care professionalism cycle and a care-competence cycle to provide a conceptual framework for address- ing the crisis. I conclude that medicine’s position is no longer as the center of health care but rather as another node within a wider evolving health care network. And the resolution of medicine’s professionalism crisis depends on medicine’s positioning and defning itself in terms of the professionalism for each of the other professions within the health care network. Keywords Commercialization · Edmund Pellegrino · Francis Peabody · Professionalism · Scientifcation * James A. Marcum james_marcum@baylor.edu 1 Department of Philosophy, Baylor University, Waco, TX 76798, USA