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Health Care: It's Not What It Used To Be


Article # : 17064 

Section : INTRODUCTION
Issue Date : 8 / 1990  1,765 Words
Author : Edmund F. Haislmaier

       What should the role of physicians be in today's and tomorrow's health care system? That is the central question discussed in the following essays.
       
        Play a word association gam,e and invariably, the word doctor will be most people's first response to the words medicine or health care. Indeed, the response is justified, for the doctor is still the central actor in the health care system. It is the doctor who identifies or defines problems, prescribes remedies, and manages or effects cures. The rest of the edifice of America's health care system, whether physical, administrative, or human, still exists largely to serve the doctor.
       
        Yet that perception is changing. While much of the change originates in forces and concerns outside the profession, it is most acutely felt within. It is physicians themselves who are most frequently and explicitly asking: "Who are we, and what is to become of us?"
       
        Is the doctor a "demigod" with power of life and death, whose judgment is owed respectful deference, whose word is owed obedience, and whose altar is owed an ever-growing tribute of financial and technological resources? Some recall what they view as a "golden age" of medicine, when the answer to this question, they believe, was "Yes." They bemoan the impiety of a people who have removed the doctor from his place of prominence in the temple of medicine and seek to restore him to his rightful throne. Yet if such a "golden age" ever existed, it was for no more than two or three decades following the end of World War II and can be viewed more as an aberration than an ideal.
       
        Furthermore, by what right do physicians claim such sweeping and unquestioned authority? Is it because of their power over life or death, or their capacity to do good or harm? If so, then such powers are not unique to the medical profession and do not justify a lack of restraints. Indeed, other professions with similar powers (the political, judicial, and military to name the more obvious), are held more, not less, accountable and their actions carefully circumscribed by clearly defined boundaries, however broad, precisely because of the gravity of power entrusted to them.
       
        Is the doctor the patient's advocate, serving as an agent with the information, expertise, authority, and, indeed, moral obligation to commandeer whatever goods or services are necessary for the patient's well being? A great many physicians who might not go so far as to think themselves demigods cherish this
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