(Part of the following is from an earlier commentary with slight editorial tweaks and some additions.)
Thomas Szasz wrote brilliantly about the power of language.
"The struggle for definition is veritably the struggle for life itself. In the typical Western two men fight desperately for the possession of a gun that has been thrown to the ground: whoever reaches the weapon first shoots and lives; his adversary is shot and dies. In ordinary life, the struggle is not for guns but for words; whoever first defines the situation is the victor; his adversary, the victim. For example, in the family, husband and wife, mother and child do not get along; who defines whom as troublesome or mentally sick?...[the one] who first seizes the word imposes reality on the other; [the one] who defines thus dominates and lives; and [the one] who is defined is subjugated and may be killed."In short, define or be defined. In the very recent past,within my medical professional life time , physicians in many ways defined their role.Their role was to act as a fiduciary to their patients,to do no harm and act in the interest of their patient.Now their role is being redefined as stewards of the collective medical resources.Yes, it has been members of the medical profession,largely a small group of internists, who have spear headed this effort to redefine medical ethics and have been able to implant those views in the medical schools and in post graduate curriculum and their new professionalism has at least been given lip service in over one hundred medical organizations.. While I would not impugn the motives and sincerity of those physicians who have promoted that view and value system,I cannot resist applying the often useful Mafia Rule. Follow the money.Who gains from transforming physicians into health care providers and resource stewards and tasking them with saving money for the health care collectives? Is it "society" or various medical collectives (HMOs,ACOs), who have hoodwinked us into accepting the colossal lie that their bottom line corresponds to some greater societal good.
Dr. Szasz : "In the animal kingdom, the rule is, eat or be eaten; in the human kingdom, define or be defined. "
In the last 25 years physicians have allowed themselves to be redefined in such a way that they have lost their independence, integrity and have sacrificed their prime directive of a fiduciary
duty to the patient to a nebulous,elastic vision of serving the community.