Ever since variation was declared to be an enemy of medicine there has been a multifaceted unrelenting effort to constrain the autonomy of clinicians.
In an article in the Medical Humanities journal titled “Stepford doctors”: an allegory GM Sayers described this trend creeping towards the ultimate creation of a workforce of Stepford doctors.
From the paper:
The Stepford Wives, a novel by Ira Levin, provides the theme for this allegory. The men of Stepford belong to the Men’s Association. Their wives are “perfect”, in that they do nothing other than clean, cook, preen, and provide satisfaction without argument for their husbands. They are, furthermore, content with their lot, and believe that their previous interests and freedoms were self indulgent.
allegory to hospital medicine, Sayers wrote:
In the hospitals, doctors were pooled and moved like pawns to fill clinical slots, by masters who controlled both board and pieces...
The masters were not doctors; they were experts in managing time, costs, and doctors. They had not studied medicine, bioethics, or humanities; they were devoid of empathy. They did not treat patients, perform operations or do clinical research. They did not break bad news or get consent from patients for surgery. Nevertheless, they knew what sort of doctors they wanted—‘‘Stepford doctors’’. These were not ‘‘excellent’’ doctors, but ‘‘good enough’’ doctors, who would devote themselves to the masters’ objective of expediency, and the masters’ duty to balance the budget.
It is not completely clear how the masters changed the thinking and acting of so many doctors, but they did. Some of the doctors accepted the superficial plausibility of the reasoning that informed the masters’ demands. Some of the doctors themselves became masters, and they persuaded other doctors that the way the masters saw medicine was the way medicine should be.
The article was published in 2006 and might be considered dated but the premise is even more relevant today. In the words of the author: “This allegory cannot be concluded because it is on going.”