By Brooke Miller at Brownstone dot org.

The Transformation of Medicine: From Healers to Healthcare Workers

I had the privilege of addressing the American Association of Physicians and Surgeons this past Friday at their annual meeting and convention. I spoke on a topic that I'd never addressed publicly before, but one in which I feel quite versed through hard-won experience. During my medical career, which spans four decades, I've witnessed profound changes in medicine.

But what we've seen happen over the past decade isn't just change - it's a fundamental transformation that should frighten every American who values quality healthcare.

When I began my career in the 1980s, physicians were truly independent professionals. We owned our practices, made clinical decisions based on our training and experience, and were accountable primarily to our patients and our consciences. The doctor-patient relationship was sacred, protected by both medical ethics and legal precedent. We had time to listen, to think, to develop comprehensive treatment plans tailored to each individual patient.

Today's reality is starkly different. Physicians are no longer in control of our profession. We've witnessed unprecedented interference and control over every facet of medical care, and it's accelerating at an alarming pace. What troubles me most deeply is not just the external pressures we face, but how these pressures have fundamentally changed the physicians themselves.

I've observed a definite decline in the attitude many doctors take toward their patients. There's a troubling loss of confidence in clinical decision-making and a diminished ability to think critically about disease and illness. Too many physicians have abdicated responsibility for patient outcomes, hiding behind protocols and guidelines rather than taking ownership of their clinical decisions.

Perhaps most concerning is the apparent lack of empathy many now show toward a patient's fundamental right to make informed decisions about their own healthcare.

The transformation is psychological as well as structural. As a profession, many feel a profound loss of authority in directing treatments. Physicians who once confidently prescribed based on their clinical judgment now feel compelled to ask for permission to deviate from standardized guidelines - even when their experience and the patient's unique circumstances clearly warrant a different approach.

This shift represents more than professional frustration; it's a betrayal of the trust patients place in us. When I took my oath decades ago, I promised to "First, do no harm." Today, many physicians find themselves in positions where following institutional protocols may actually harm patients, yet they feel powerless to act on their clinical judgment.

The corporatization of medicine has reduced many physicians from independent professionals to healthcare workers - employees who implement corporate policies rather than medical doctors who heal the sick. Electronic health records have transformed us from healers into data entry clerks. Prior authorization requirements have made us supplicants, begging insurance companies for permission to treat our patients.

Quality metrics have reduced the art and science of medicine to checkbox exercises that ignore the complexity of human health and disease.

Perhaps most insidiously, the financial pressures and employment models have created a generation of physicians who have never experienced true clinical independence. They've been trained in systems where protocol compliance matters more than patient outcomes, where productivity metrics drive decision-making, and where questioning authority is discouraged or punished.

The Covid-19 pandemic exposed these problems with devastating clarity. Physicians who dared to think independently, who questioned protocols that weren't working, or who advocated for their patients' individual needs faced professional destruction. The message was clear: conform or be d...