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

This book addresses the fundamental conflict of interest that physicians face in their daily work lives between the ethics of proper medical care versus the demands of standard business practices. However, unlike other books of this sort, this one places direct responsibility for this ethical dilemma upon the shoulders of physicians themselves. Taking ethical, legal, and business perspectives into account, the book traces the historically evolving response of American physicians to ever-increasing business interests within the profession. These financial concerns now have become intrinsic not only to the practice of medicine but seemingly also to the character of a growing segment of its practitioners. The book offers a plea for a change to a more socialized healthcare system as used in other advanced nations.




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.