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
51 Shares
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

More by 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

  • The hidden gems of health care: Unlocking the potential of narrative medicine

    Dr. Najat Fadlallah
  • The dark side of immortality: What if we could live forever?

    Ketan Desai, MD, PhD
  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech

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

CME Spotlights

From MedPage Today

Latest News

  • Our Organ Transplant System Isn't the Failure It's Made Out to Be
  • 2-Minute Clinic: Can You Name This Disease of the Female Reproductive System?
  • Blood Thinner Recall; Marburg Cases Triple; E. Coli in Meat May Cause 500,000 UTIs
  • Sam Neill's Rare Lymphoma
  • Day in the Life of a Doctor: Treating a Patient With Septic Shock

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast
    • What I think it means to be a medical student in the wake of AI

      Jackson J. McCue | Tech

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • 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...