Price of Escape from Freedom for Independent Physician

Freedom, although it has brought independence and rationality, has made him (modern man) isolated, and thereby, anxious and powerless.

Erich Fromm (1900-1980), Escape from Freedom

January 3, 2012 -  I was speaking to a medical school classmate of mine, a surgeon.   I asked how he interpreted health reform events. He spoke of individual physician freedoms and decision making.  He said he felt  handing over those functions to government and large organizations had a price.  

He felt it made conventional  sense  that:

·        many heads were better than one;

·        more data was better than less data;

·        high information patients were better off than low information patients;

·        coordination was preferable to individualism.

But something was lost in the process.    He explained, “ I have been in large group practice,  small group practice, and solo practice. And frankly, I was happier and made better decisions when I was alone.”

“I could decide what was best for the patient. I was not influenced by outside political and economic forces.  I could act quickly and decisively.”

“I could talk to patients directly and give them their options.   I did not have to wait for some third parties’ opinion based on what was best for the organization.”

“Young doctors feel differently.  As solo decision-makers, they feel isolated, anxious, and powerless. That’s why most of them join hospitals and other organizations.  That’s why they leave they leave much  of the decision making to their employers and best-practice protocals."  

"I understand  younger doctors’ mindsets.   But something is lost in the process.   There is a price to be paid.”

Tweet:  Older doctors cherished their freedom in decision making.  Younger doctors rely more on data, clinical algorithms, and team decisions