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There is no question about it. In the issue of patient autonomy, the
author has the better arguments, the more just and the more moral position
– but seems to lose the debate. Yet arguments are rarely about the surface
discussion, rather they reflect a deeper malaise, and here is a case in
point. I suspect that what exercises doctors (and the public to judge by
the reaction in this debate) is the increasing homogenisation of clinical
practice that modern medicine demands. Guidelines, pathways, and
conformity can stifle and ultimately extinguish innovation and invention.
Medicine is in danger of producing functionaries, who adhere to protocols.
They can do the science, but have lost the art of medicine. I do not
believe anyone really wants to go back to the good old bad old days, but
the audience wanted to stick one in the eye to our worrying obsession with
procedure, tick boxes and protocols.
Competing interests:
None declared
Competing interests:
No competing interests
24 June 2009
Alastair M Santhouse
Consultant in Psychological Medicine
South London and Maudsley NHS Foundation Trust, Guy's Hospital, SE1 3RR
The ambivalence of the public
There is no question about it. In the issue of patient autonomy, the
author has the better arguments, the more just and the more moral position
– but seems to lose the debate. Yet arguments are rarely about the surface
discussion, rather they reflect a deeper malaise, and here is a case in
point. I suspect that what exercises doctors (and the public to judge by
the reaction in this debate) is the increasing homogenisation of clinical
practice that modern medicine demands. Guidelines, pathways, and
conformity can stifle and ultimately extinguish innovation and invention.
Medicine is in danger of producing functionaries, who adhere to protocols.
They can do the science, but have lost the art of medicine. I do not
believe anyone really wants to go back to the good old bad old days, but
the audience wanted to stick one in the eye to our worrying obsession with
procedure, tick boxes and protocols.
Competing interests:
None declared
Competing interests: No competing interests