How Medicine Is Contributing To Its Own Demise

Philip G. Ney, MD FRCP(C)

January 10, 2006

Although there are many social and political forces undermining the practice of good medicine, I believe most of the difficulty arises from within medicine itself.

There are at least 10 reasons:

1. All types of health care givers inadvertently reinforce maladaptive behavior. Concern and treatment follow the expression of distress and unhealthy behavior by patients, thereby reinforcing the very problems that health care professionals are ostensibly attempting to correct.

2. Health-care professionals, and physicians in particular, encourage unrealistic expectations of health and longevity. These encouragements range from "of course you're going to get better" to "although there is a 50 percent chance of surviving five years, I like your positive attitude."

3. Emphasize short-term relief rather than long-term resolution. Most psychiatrists are inclined to prescribe antidepressants instead of psychotherapy for complicated grief, for example.

4. Avoid struggling with the patient when wrestling with chronic illness. When physicians empathize with their patients, they experience vicariously the patient's pain-filled effort. That, together with their own effort to understand and treat, can make them very tired. It so much easier to prescribe and go golfing.

5. Allow social and political forces to undermine professional independence. Referring to patients as clients is indicative of the health-care professionals relinquishing professional prerogative and being unduly swayed by patient choices.

6. Contributing to the Post-Abortion Survivor Syndrome. Those people whose siblings have been aborted distress authority in general and doctors in particular.

7. Disregard evidence based medicine in certain areas altogether. It is impossible to abort a woman's pregnancy according to her choice and according to scientifically determined indications at the same time.

8. Abandon ancient ethics. The Hippocratic Oath compelled doctors to never: abort a woman, poison a person, or have sex with a patient. The incidence of doctors breaking these three appears to be increasing.

9. Avoid discussing death. When doctors cannot deal with the prospect of their own demise, they will avoid helping patients discuss death.

10. Emphasize earnings and lifestyle instead of dedicated service.

The net effect of these trends is declining credibility in physicians. After approximately 23 centuries the Hippocratic Oath engendered trust in the majority of patients. Without trust physicians now must rely on popularity to gain their patients compliance. To be popular the physician must appear to accept popular morality. No amount of playing politics can improve declining credibility. All health care professionals must adhere to the practice of evidence-based medicine for every medical, surgical or psychiatric procedure and to well-proven ethics.