Interesting discussion--
Those of us of a certain age have seen a lot of change in the profession, but of course, we were warned by our elders when we were in training that the future would be very different from what we experienced in the 60's and 70's, and so it has been.
The changes we have all been discussing and commiserating with each other about really started a very long time ago -- probably in the early 19th century, when medicine actually became
useful and not just the province of the elites -- but therefore of interest to the the general public and the government. Different countries and different governments have taken somewhat different approaches -- but in all cases, what was once a very private matter between a physician and his (mostly
his) patient has become commodified-- that is, controlled by the market, and industrialized -- that is, controlled by an administrative class. This is true whether you are discussing "socialized" medicine like England or Sweden, or "free market" medicine as in USA. In any case, physicians have lost the ability to control the agenda.
Hippocrates' first aphorism states -- although we have all heard it, few have actually read it in context:
"1. Life is short, and Art long; the crisis fleeting; experience perilous, and decision difficult. The physician must not only be prepared to do what is right himself, but also to make the patient, the attendants, and externals cooperate."
In other words, a major part of the "art of medicine" is to be like a theatrical director -- no matter how good the script or the individual actors, you have to be able to manage all of the elements of a play to make it work. The directorship has been taken from us -- given to functionaries and "bots" in insurance company and government offices -- or to the "C-suite" of large medical institutions. It remains to be seen if they will rise to the occasion. It doesn't look good to me.
Paul Starr, Princeton University professor of sociology, wrote an amazing book in 1982, which I first read in about 1983, but remains relevant -- most of his history has proved to be accurate and most of his predictions have come to pass:
Paul Starr: Social Transformation of American Medicine The Social Transformation of American Medicine: The Rise Of A Sovereign Profession And The Making Of A Vast Industry
Paul Starr
Basic Books, 1982 - History - 514 pages
1 Review
Winner of the 1983 Pulitzer Prize and the Bancroft Prize in American History, this is a landmark history of how the entire American health care system of doctors, hospitals, health plans, and government programs has evolved over the last two centuries.
"The definitive social history of the medical profession in America....A monumental achievement."—H. Jack Geiger, M.D., New York Times Book Review
At this point, I regard my practice as something of a social aberration -- more a hobby than a real job. Like Cervantes' Don Quixote, I am still tilting at windmills -- with no effect on the system that has squashed me. But I have a quiet hidey-hole where my wife and another anachronistic doctor associate can practice mid-20th century style medicine, and we are happy, and the patients love us for it.
