Medical professionalism emerged in the Western Europe a few hundred years ago where the role of the doctor was partly controlled by professional guilds which gave way to self-regulation. In the mid to late 20th century certainly in the uk and the us many medical scandals occurred which changed the perception of self-regulation and the perception of the role of the doctors. Although in most surveys doctors are still the most trusted group say compared with politicians and journalists, this trust has to be earned. In the uk there were some serious scandals in the last quarter of last century in pathology, surgery and psychiatry which shook the medical establishment. As a result various institutions including the Royal College of Psychiatrists the role of medical professionalism is being redefined. In the last year the College has worked with stake holders including politicians, journalists, employers, other professionals and patients and carers in identifying core concepts of psychiatric professionalism. With changing patient expectations and an increase in patient knowledge base through the use of the internet and other sources, the earlier notions of doctors having all the knowledge is not sustainable. This also means that we need to work somewhat differently with patients and carers. Some of these challenges along with other advances in treatment such as pharmacogenomics will lead to a major shift in relationship between patients, their families and psychiatrists including changes in ethical expectations. Some of these issues will be highlighted and discussed in the presentation. Potential problems and some solutions will be brought together so that the profession can work together with other stake holders in delivering standards of service which will be acceptable to the society at large.