Doctoring 2009

Abstract

Doctoring faces many challenges in 2009, all potentially imperiling our professional soul or ethos of life as doctors. The field of medicine in the United States has never been more fulfilling, yet our dreams and those of our patients are clouded by a sense of unfulfilled promise and our practices are mired in policy restraints. I believe it is possible both to restore meaning to our debate with policymakers and optimism to our profession. To do so, we must rescue medical professionalism from what is becoming an entrepreneurial occupation in which we are asked to deliver a commodity. We must return our principal attention to humanity to ensure that ill humans will always be more than integers on an economic chart. In this review, I discuss economic, medical, and social planning philosophies which contribute to our current dilemmas yet also provide insights and opportunities for their resolution. I discuss medicine’s past and present responses to its challenges and outline a new method of dialogue to accomplish our objectives of better quality and more cost-effective education, research, and clinical care for all. As the escalating coste1-e4 of health care in the United States exceeds that of any nation on earth, economic planning is essential. Much present-day health care delivery dysfunction is the consequence of economic manipulation of physician behavior in the absence of consideration of our ethos. I am neither against social planning with economic ends nor economic planning with social ends, but I am against both when doctrinaire, and not part of a larger humanistic whole. Elements of recent neuroscientific discoveries serve as the foundation of my thoughts and conclusions. Our human capability and drive toward economic and social functioning confirms a biologic basis for the need for concurrent economic and humanistic planning of health care delivery. Both Glimcher …