The Changing Character of Medicine: Are We Headed in the Right Direction?

When you are ill, do you go to your physician to receive a government (or industry) derived practice guideline? Or do you want your physician to be able to apply his independent judgment to your individual situation? Which kind of doctor is more likely to be willing to rely on his own judgment in service of your individual best interests? One steeped in the ethics of social justice, beholden to a third-party for payment? Or a physician whose livelihood is directly related to and primarily dependent upon the quality of care he provides to you, the patient?

What if you have an unusual illness, or even a common illness for which a new but not yet thoroughly tested and approved treatment is available? Which physician would be more likely to suggest and/or support an innovative treatment? A doctor whose job depends on keeping the politicians or administrators happy, or the physician whose primary loyalty is to you?

Not only will individual patients suffer from the lack of courageous doctors and patients pushing the envelope of medical knowledge and experience, but society, too, will miss out on innovations and advances. Drs. Jonas SalkLouis Pasteur, Thomas J. FogartyAlfred Blalock, and Vivian Thomas, to name a scant few of the many heroic pioneers in medicine, did not achieve their breakthroughs by following standard practice.

Another point to consider: How much of the professional pride and independence which employed physicians currently maintain is the result of the pre-existing professional culture of physicians as independent businessmen? What will happen when the field is no longer dominated by these entrepreneurial individuals? What will happen when young men and women who want to be their own boss no longer apply to medical school because the standard practice of medicine is that of a salaried employee? Or when the over-regulation of medicine has destroyed the satisfaction and profitability of private practice? Is this a cultural change we wish to encourage?

A significant aim of ObamaCare is to set up structures and mechanisms for monitoring and controlling physician behavior using ACOs designed to corral physicians into centrally controlled payment plans. The ACOs are also configured to use electronic medical records as a quality control and payment device, as well as comparative effectiveness research along with “best practices” guidelines -- all of which are helpful when employed in an advisory role, but which suffocate innovation and prevent customization when variance is punished.

If we are to preserve medical excellence, in quality, efficiency, and innovation, we must not simply preserve independent thinking; we must actively promote and nurture it. A physician's primary orientation must be to the reality of his patients and their specific medical conditions. In a free country, working as or seeking medical care from an employed physician is one of many important alternatives. But using government to give legislative and regulatory preference to this mode of health care delivery over that of private practice is not only an anathema to freedom, it is an anathema to the independent minds of doctors and patients.