Can we learn and practice medicine well in a system that is so ill?

In his book, The Present Illness, American Health Care and Its Afflictions, physician and historian Martin Shapiro, MD, PhD, MPH presents a scathing critique of a profession suffused with status, money, and power. At the same time, he also describes many deeply caring and rewarding patient care experiences, his own and those of colleagues.  But these relationships are only possible when the clinician has a clear understanding of the pernicious corrupting forces in medicine and consciously rejects them.  This is a moral act that must be renewed continuously. They also require a capacity to confront one's own insecurities -- Dr. Shapiro describes years of psychotherapy that were essential to his own growth as a physician who can be fully present in the face of suffering.   Martin indicts the profession for producing far too many doctors who want to get rich and who are unprepared, through a faulty process of selection and training, to be truly caring towards those they serve.  Martin reminds us that the motives of the profession have long been suspect, quoting Plato's Republic in which Socrates asks, "Is the physician a healer or a maker of money?" Never before, however, and nowhere on the scale found in the United States has health care become such a massive industry, one that keeps growing. Martin argues that the profession can only heal itself if it confronts its demons honestly and openly, beginning at the earliest stages of medical training.