The long running,thoughtful blog "DrWes" discusses an important issue .See here.
The author is Dr.Westby G. Fisher,a cardiac electrophysiologist from Illinois.
Quoting Dr. Fisher:
"Doctors are currently witnessing the profession of medicine moving from
the ethic of the individual to the ethic of the collective. The passage
of the Affordable Care Act has solidified this treatment ethic and, as a
consequence, often creates conflicts between the treating physician and
their individual patients.
Nowhere is this shift to the ethic of the collective clearer than our
expanding attempt to determine treatment "appropriateness" using a
look-up chart of euphemistically-scored clinical scenarios owned and
trademarked as "Appropriateness Criteria®" or "AUC®" by our own medical professional organizations."
A important-perhaps critical-step in this shift was the effort to change medical ethics. At least nominally this has occurred. I believe this conceptual sea change was largely brought about -at least in the United States- about by a relatively small number of physicians who I describe as the progressive medical elite. Influential folks in the American College of Physicians and the American Board of Internal Medicine and its foundation , the ABIM Foundation, are among those who have lead the charge.I have written about this development more than once. See here details on this sea change in ethics.
These new ethics and a movement labelled medical professionalism push the fiduciary duty of the physician to the patient past the back burner and attempts to shove that notion into the memory hole. This duty has ( had?) been the fundamental core of the physician patient relationship. Try and find the word "fiduciary" in the most recent rendition of medical ethics from ACP or in the white paper on Medical Professionalism.
The first encounter I had with this notion of treat the collective not the patient was in a series of articles in JAMA in 1995 written by Dr. David Eddy in which he promised to show the medical world how to increase quality while conserving costs. The answer was simply to allocate resources in a medical collective ( such as an HMO) using some version of cost benefit analysis so as there would be achieved the greatest benefit to the greatest number, i.e. utilitarianism.Letters to the editor raised the issue of the upending of traditional medical ethics, the tort system which did not and does not recognize a utilitarian defense of harming the individual patient to benefit some statistical aggregate and the basic human tendency to act in one own perceived best interest and those of their family and not that of some possibly hypothetical collective.The dogs barked and the caravan moved on and currently we see that this duty to the collective notion has hijacked traditional medical ethics and I fear is doing the same to medical education.