Is Physician Autonomy Dead?
The Call to Disobey
In a recent article on Medscape, Howard Waitzkin, MD, PhD, describes the final employer-imposed mandate that put him over the edge and resulted in his very personal decision to disobey. His obvious frustration and inability to change edicts, regulations, and rules that he perceived as having questionable value and undermining physician autonomy led to an obvious question. To borrow a phrase: Should physicians “just say no”?
We asked our readers what they thought, and although the majority agreed with the position that, at some point, disobedience is required, some disagreed and left many passionate comments.
Most respondents to this question, as well as the majority of readers who joined in the discussion by submitting anecdotal comments, agreed that at some point enough was enough. That position was well summed up by one internist:
Isn’t it enough [that] I have to be an expert on how to take care of a human being? Must I be an expert in all this administrative stuff as well? My degree is in medicine, not billing and coding. When the billers and coders can do my job, I will happily do theirs.
Another internist lamented that medicine “has become all about the almighty dollar and nothing about the care of patients.” Numerous comments related to concerns with one-size-fits-all tasks that enforced standardization—think paperwork, bureaucracy, electronic health records, rather than individualization—with a goal of meeting the needs of the corporation rather than those of patients.
And it was not only physicians who voiced concern about the plethora of externally applied mandates and regulations. A pharmacist reader emphasized the importance of placing patients, rather than uniformity, first, noting that “physicians and other healthcare personnel should not be treated as if they were robots. They have an ethical duty to treat their patients professionally and with great care for the patient’s overall well-being.”
One nurse ironically chimed in: “Now you know what it has always been like to be a nurse.”