Authoritarian Medicine

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It was three am in Nandi International Airport in Fiji. All of the passengers had cleared customs and left the terminal. Only three of us remained. It was not hard to spot the other doctor, an ENT from Homberg, Germany. The third gentleman was a British Health Service bureaucrat from England in Fiji to share the English version of central management of healthcare with the emerging Fijian Healthcare system. We were all waiting for rides which may not have anticipated our early arrival.

Wolfgang and I immediately hit it off. We were both volunteers with Rotary International, in Fiji to participate in a Health Fair throughout many of the underserved villages. After a few minutes, the Englishman came over and introduced himself enthusiastically presenting his views on standardized healthcare. Wolfgang and I spent the next two hours arguing that standardization negated the scientific nature of clinical practice, where in trial and error takes place massively throughout the profession resulting advancements in care for the patient, communicated almost by word of mouth on a realtime basis. We argued that statistics and scientific studies were a necessary reference but not a certain conclusion. Many studies were selected for or conflicted by those conducting the studies and many studies proved wrong by subsequent trial but with substantial time lag.  Neither side won the argument back then, and our rides soon arrived.  This airport debate was twenty years ago, and the evolution of  authoritarian medicine dominated English medicine and now distorts healthcare in the US. 

The American version of authoritarian medicine features additional elements of greed and politics, along with massive bureaucracy. Starting with the theory of "Evidence based Medicine," medical science became the purview of the growing medical bureaucracy, then hospital administrators, corporate medicine, politicians and big pharmacology. The burdens today's physicians face, match or exceed the burdens of various religious dictates during the Dark Ages. No longer medical science and patient care, doctors now practice with political correctness, censorship and manipulated evidence. Today, I read that the AMA has come out in support of Critical Racial Theory. Politics and greed have no business in medical practice and patient care. Patient care, patient satisfaction, current science, treatment outcome, the physicians judgment and local medical societies should be the only authority in medical practice. Authoritarian-guidelines negate the scientific method and inductive reasoning. Evidence is good. guidelines can help, but bureaucratic regulation or administrative regulation cannot. Now the AMA wants to replace merit based medical school admission standards with social standards. Such a move favors corporate medicine and social medicine producing young obedient feldshers who will not question the authoritarian mandates or the political and economic motives -- over clinical judgment, medical science and patient care. We desperately need to reaffirm the Aesculapian mandates of Western medicine and resist the Marxist authoritarianism, greed and politicalization of medicine.