This husband and wife physician team from Harvard Medical School have published cogent thoughts before regarding serious issues in current day medical practice.See here for their critique of the concept of quality adjusted life year (QALY) and here .
They contend that medical care is being corrupted by the actions of several groups-insurers,hospital networks and regulatory groups.I would add that philosophical (ethical ) cover is provided by health policy experts who are attempting to change medical ethics from one in which the physician has a strong,primary fiduciary duty to her individual patient to one in which the physician is obligated to act in the alleged benefit of the group.This attempt is exemplified by the New Professionalism initiative which is spearheaded by the American College of Physicians (ACP) and the American Board of Internal Medicine (ABIM and its foundation (ABIMF) and the Robert Wood Johnson Foundation (RWJF). Additionally, the movement for a "Population Medicine " approach depends heavily on this sea change in medical ethics.Simply put- the population medicine approach is dead in the water unless physicians reject their traditional fiduciary duty to their patient.
Quoting the authors from their NYT article:
" Insurers, hospital networks and regulatory groups have put in place both rewards and punishments that can powerfully influence your doctor’s decisions.Contracts for medical care that incorporate “pay for performance” direct physicians to meet strict metrics for testing and treatment. These metrics are population-based and generic, and do not take into account the individual characteristics and preferences of the patient or differing expert opinions on optimal practice."
"When a patient asks “Is this treatment right for me?” the doctor faces a potential moral dilemma. How should he answer if the response is to his personal detriment? Some health policy experts suggest that there is no moral dilemma. They argue that it is obsolete for the doctor to approach each patient strictly as an individual; medical decisions should be made on the basis of what is best for the population as a whole
addendum: 12/27/14.Minor spelling and punctuation corrections made and on 6/5/15