Certain members of the leadership of the American College of Physicians,the American Board of Internal Medicine and the Robert Wood Johnson Foundation authored a manuscript designed to permanently change the physician patient relationship.The paper is entitled "Medical Professionalism in the new millennium: A Physician Charter.",.which I will refer to in this commentary as "The Charter" . It was a project of the foundations of the ABIM and ACP and the European Federation of Internal Medicine.See here for the document.
The documents simply asserted that physicians are the stewards of a [collectively owned] store of medical resources and that physicians have a professional obligation to work for social justice. While they did not explicitly deny the fiduciary role of the physician to the patients in effect they declared that there was a co duty to conserve the "limited" medical resources as well as the duty to the individual patient.Contrary to the biblical warning about serving two masters the Charter's authors urge a stewardship of medical resources which subsequent publications by ACP,ABIM and others said will best be made operational by physicians following guidelines.
In my opinion this publication is a poster child for the use of gratuitous assertions.
Quoting from the Charter" essential to the contract [medicine's contract with society] is the public trust".
The Charter was published in the Annals of Internal Medicine and Dr. Harold Sox, the then editor of the Annals of Internal Medicine, offered an introductory commentary. He said in part "the condition of Medical Practice are tempting physicians to abandon their commitment to the primary of patient welfare....the Charter call physicians to promote fair distribution of health care resources"
I suggest that the choice of the words "primacy of patient welfare" is significant in the omission of the modifier "individual" in front of the word patient. Subsequent promotion of the Charter has made it clear that patient welfare will be defined in terms of the aggregate not in terms of the individual patient. A subsequent publication ( JAMA: November 13,2013) by Dr. Sox advocating "population Medicine " made it clear what type of patient welfare Dr Sox favored. See here.
A brief quote from Sox; "
"Perhaps the de facto organizing principle for US health care,approaching each patient strictly as an individual is obsolete.The population health approach is an alternative." (I have added the bolding)
Dr. Sox makes explicit what is hinted at and glossed over in the charter,namely the sacrifice of the individual to the group, the individual patient to the aggregate, or at least to some aggregate metric claimed to represent the good of the group.
The charter promised social justice and operationally that has been translated to following guide lines based on alleged aggregate benefit.