Too Conscientious: The Evolution of Ethical Challenges to Professionalism in the American Medical Marketplace

Dr. Douglas Lemley is a retired physician and a 1982 graduate of the West Virginia University School of Medicine. After completing residency and fellowship training programs at the University of Florida and Georgetown University, he practiced internal medicine and rheumatology in North Carolina until 1997. Growing increasingly weary of the intrusive constraints of managed health care of that time, he departed general practice to pursue a second area of medical training. During another five years of residency and fellowship education in radiology and musculoskeletal imaging at The Ohio State University and Duke University, he served as a chief resident and national chairman of the Resident Section of the American College of Radiology. Practicing primarily as a locum tenens and teleradiology physician, his work took him to multiple locations throughout the eastern United States and California. During both phases of his medical career, he maintained a keen awareness of the frequently conflicting medically ethical and business savvy interests inherent to the practice of modern medicine. Favoring the quality of his work over productivity, he once was dismissed from a job on alleged charges of literally being “too conscientious” in his work. He retired from medical practice in 2015. Soon thereafter, he enrolled at Wake Forest University where he earned a master’s degree in bioethics in 2017. This work arises from his extensive personal experience fortified by in-depth research performed in the course of developing his postgraduate thesis. 

Chapter 1. "Too Conscientious" - Marketplace Realities Confront Medical Professionalism.- Chapter 2. The Rise and Fall of the American Medical.- Chapter 3. Twentieth Century Evolution of American Medical Business Interests: Insurance, Funding, and the Seeds of Federal Managed Care.- Chapter 4. As American Society Evolves so Does Medicine: Autonomy, Informed Consent, and Liability.- Chapter 5. Open for Business: New Management for the "Doctors' Workshop".- Chapter 6. Welcome to Medicine, Inc.: Professionalism v. Production.- Chapter 7. Physicians and Businessmen: Contradictions in Health Care.- Chapter 8. Autonomy, Agency and Advocacy: Seeking Medicolegal Alliance.- Chapter 9. Medicine and the Courts.- Chapter 10. Financial Conflicts of Interest in Medicine: Effects and Theories of Causation.- Chapter 11. The Internal Morality of Medicine: A Matter of Faith.- Chapter 12. Social and DistributiveJustice in Health Care.- Chapter 13. An Uncertain Future for Medicine: Business or Profession?.