July 25, 1986

Professional Ethics and Primary Care Medicine: Beyond Dilemmas and Decorum

Author Affiliations

Internal Medicine Associates of Springfield (Mo) Inc


by Harmon L. Smith and Larry R. Churchill, 117 pp, $25, paper $9.95, Durham, NC, Duke University Press, 1986.

JAMA. 1986;256(4):531-532. doi:10.1001/jama.1986.03380040105040

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"Medical-ethical problem-solving is not a generalizable and repeatable exercise in logic; it is an examination of the moral motivations and sensibilities which constitute us as a 'doctor' or a 'patient.' " This statement contained in the introduction promises a close examination of the day-by-day ethical considerations involved in the physician-patient relationship. In the subsequent five chapters, the authors present, in a generally readable and cohesive fashion, the concept of the primary care physician's role in a "new" form of ethics involving a sense of collaboration and mutual interdependence between the physician and patient.

Initially, the reader is introduced to a character or virtue-based ethic termed the moral imagination. The moral imagination is defined as the character, ideals, integrity, and virtues of physicians that provide them with the background for moral problem solving. Primary care medicine is viewed as a unique area of medicine best suited to incorporate this system of ethics