Dr. Aaron Kheriaty has a great article over at the Brownstone Institute that describes the revolution that has been taking place in the field of medicine. It is a revolution that places “managers” over physicians and their decisions on behalf of patients. He describes four key features or tenets of this revolution:
The first is Technocratic Scientism, or the belief that everything, including society and human nature, can and should be fully understood and controlled through materialist scientific and technical means, and that those with superior scientific and technical knowledge are therefore best placed to govern society. In medicine, this manifests through the metastatic proliferation of top-down “guidelines,” imposed on physicians to dictate the management of various illnesses. These come not just from professional medical societies but also state and federal regulatory authorities and public health agencies.
“Guidelines” is in fact a euphemism designed to obscure their actual function: they control physician’s behavior by dictating payments and reimbursement for hitting certain metrics…
EBM proponents claim we should only use the “best available evidence” to make clinical judgments. But this sleight-of-hand is deceptive and wrong: we should use all available evidence, not just that deemed “best” by self-appointed “experts”…
The second tenet of our managerial ideology is Utopian Progressivism, or the belief that a perfect society is possible through perfect application of scientific and technical knowledge and that the Arc of History bends towards utopia as more expert knowledge is acquired…
The third feature of the managerialist ideology is Liberationism, the belief that individuals and societies are held back from progress by the rules, restraints, relationships, historical institutions, communities, and traditions of the past—all of which are necessarily inferior to the new, and which we must therefore be liberated from in order to move forward. Contrary to this ideology, there are some things in medicine that will never change.
At its foundation, medicine is constituted by a particular kind of relationship—a relationship based upon trust between a patient made vulnerable by illness and a doctor who professes to use his knowledge and skills always and only for the purposes of health and healing. No technological advance, no societal development, will ever alter this. The ends, or purposes, of medicine are baked into the kind of profession that it is, grounded in the realities of health, illness, and the human body.
But today, the ideology of Liberationism seeks to “free” medicine from these constraints…
The fourth feature of the managerial revolution is Homogenizing Universalism, or the belief that all human beings are fundamentally interchangeable units of a single universal group and that the systemic “best practices” discovered by scientific management are universally applicable in all places and for all peoples. Therefore, any non-superficial particularity or diversity of place, culture, custom, nation, or government structure anywhere is evidence of an inefficient failure to converge successfully on the ideal system; progress always naturally entails centralization and homogenization.
As with the so-called “clinical guidelines” discussed above, medicine has also seen the recent explosion of so-called quality metrics for medical providers and organizations. These measures, also numbering in the thousands, cost each physician at least $40,000 annually to manage—costs that get passed on to patients.
None of this improves medical outcomes. In fact, they often worsen medical outcomes by mandating a one-size-fits-all approach to clinical care. This compromises physicians’ appropriate clinical judgment and discretionary latitude. Doctors are pushed to hit metrics on measurements like blood pressure even if this does not actually improve meaningful outcomes like heart attacks or strokes…
What primarily ails medicine is not just technical problems, or economic challenges, important as these issues are to address. Our deepest problems are philosophical, fueled by ideologies that distort the nature and purpose of medicine. The iron cage created by this system is difficult for doctors to break free from. The only solution, I believe, is the development of parallel medical institutions—entirely new models of clinical care and reimbursement—started by physicians who opt out of this perverse system entirely…
Medicine has always been hierarchical; but never has it been so conformist—with uncritical, thoughtless physicians marching in lockstep to hit metrics dictated by vested interests that show little concern for sick patients.