Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

How the postmodern ethos challenges medical professionalism

Arnold R. Eiser, MD
Physician
April 19, 2014
Share
Tweet
Share

Postmodern cultural values have seriously impacted medical care and the patient-physician relationship. Corporate control of medical care, computerization of medical information and consumerism in the clinical encounter, plus the destruction of the myth of the physician are all embodiments of postmodern values.

Postmodern thinkers such as Foucault, Lyotard, Levinas, and Bauman offer powerful insights  that can be applied to understand how current values have changed medical practice, including issues such as electronic heath records, the patient-centered medical home, clinical practice guidelines, pay for performance, and other recent policy implementations.

The rise of governmental, quasi-governmental, and private organizations that exert computerized, bureaucratic control over medical practice and education challenge the essence of medical professionalism, as they divert authority from the physician to the institution. Bureaucratic implementation of quality measures, and connecting these measures to reimbursements, focus attention and reward on only a few easily measured parameters of quality of care.

As a result, more difficult aspects of quality of care are ignored. These include individualizing medical care for particular patient characteristics, making accurate diagnoses, and establishing meaningful rapport with patients. The development of clinical practice guidelines is a social phenomenon and is hence socially constructed, even if serious attempts are made to base them on available clinical evidence.

Empaneled experts reach decisions that are the product of social discourse that are inevitably subjected to power relationships that are often implicit.  Ignoring this aspect of decision making imperils the optimization of medical practice and deifies a set of rules that are often helpful for a majority but imperils outliers in patient populations.

Elsewhere I have detailed how applying the guidelines of the American College of Chest Physicians for atrial fibrillation to patients with end-stage renal disease may harm them through the use of warfarin that can contribute to the lethal condition of calciphylaxis.

There is a need to acknowledge the importance of clinical wisdom in addition to adherence to practice guidelines. The focus on profits in the health care industry needs to be examined and tempered, and clinicians need to reclaim some of the professional authority that has been ceded to remote, impersonal bureaucracies.

As I note in the epilogue of my book, The Ethos of Medicine in Postmodern America: Philosophical, Cultural, and Social Considerations:

The effort to preserve a humane professional identity for medical practitioners is essential to maintaining a worthwhile and effective ethos of medical practice in the 21st century. Impersonal bureaucratic rationality will never suffice to comfort the sick, ease their suffering, and heal their wounded spirits. The computer, the corporation, and the consumerist model will not accomplish that. We still need men and women to face the suffering of the sick and patiently, personally provide that comforting and healing in an inter-subjective fashion with compassion, expertise, knowledge, humility, and respect. We cannot permit the Silicon Cage to envelop medical practice and vanquish the human spirit from the clinical encounter.

Arnold R. Eiser is a professor of medicine, Drexel University College of Medicine, Philadelphia, PA, and author of The Ethos of Medicine in Postmodern America: Philosophical, Cultural, and Social Considerations.

Prev

MKSAP: 76-year-old woman with left knee pain

April 19, 2014 Kevin 0
…
Next

ICD-10 will accelerate the demise of private practice

April 19, 2014 Kevin 27
…

Tagged as: Primary Care

Post navigation

< Previous Post
MKSAP: 76-year-old woman with left knee pain
Next Post >
ICD-10 will accelerate the demise of private practice

ADVERTISEMENT

More by Arnold R. Eiser, MD

  • What Chadwick Boseman’s death reveals about cancer prevention and risk factors

    Arnold R. Eiser, MD
  • Challenging conventional wisdom: How to reduce the risk of Alzheimer’s disease

    Arnold R. Eiser, MD
  • Paracelsus and the birth of toxicology

    Arnold R. Eiser, MD

More in Physician

  • Why more doctors are choosing direct care over traditional health care

    Grace Torres-Hodges, DPM, MBA
  • How to handle chronically late patients in your medical practice

    Neil Baum, MD
  • How early meetings and after-hours events penalize physician-mothers

    Samira Jeimy, MD, PhD and Menaka Pai, MD
  • Why medicine must evolve to support modern physicians

    Ryan Nadelson, MD
  • Why listening to parents’ intuition can save lives in pediatric care

    Tokunbo Akande, MD, MPH
  • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

    Dr. Saad S. Alshohaib
  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How early meetings and after-hours events penalize physician-mothers

      Samira Jeimy, MD, PhD and Menaka Pai, MD | Physician
  • Past 6 Months

    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • Beyond burnout: Understanding the triangle of exhaustion [PODCAST]

      The Podcast by KevinMD | Podcast
    • Facing terminal cancer as a doctor and mother

      Kelly Curtin-Hallinan, DO | Conditions
    • Online eye exams spark legal battle over health care access

      Joshua Windham, JD and Daryl James | Policy
    • FDA delays could end vital treatment for rare disease patients

      G. van Londen, MD | Meds
    • Pharmacists are key to expanding Medicaid access to digital therapeutics

      Amanda Matter | Meds
    • Why ADHD in women requires a new approach [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

How the postmodern ethos challenges medical professionalism
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...