Moving Beyond Nostalgia and Motives: Towards a Complexity Science View of Medical Professionalism.

Modern-day discourse on medical professionalism has largely been dominated by a “nostalgic” view, emphasizing individual motives and behaviors. Shaped by a defining conflict between commercialism and professionalism, this discourse has unfolded through a series of waves, the first four of which are discovery, definition, assessment, and institutionalization. The fifth wave—linking structure and agency—which is nascent, proposes to shift our focus on professionalism from changing individuals to modifying the underlying structural and environmental forces that shape social actors and actions. The sixth wave—complexity science—is more incubatory in nature and seeks to recast social actors, social structures, and environmental factors as interactive, adaptive, and interdependent. Moving towards such a framing is necessary if medicine is to effectively reestablish professionalism as a core principle.