As Physicians Today, We Must Both Represent the “System” and Disregard it


Healthcare today, in the broadest sense, is not a benevolent giant that wraps its powerful arms around the sick and vulnerable. It is a world of opposing forces such as Government public health ambitions and more or less unfettered market ambitions by hospitals and downright profiteering by some of the middlemen who stand between doctors and patients, such as insurers, Pharmacy Benefits Managers, EMR vendors and other technology companies.

Within healthcare there is also a growing, more or less money-focused sector of paramedicine, promoting “alternative” belief systems, some of which may be right on and showing the future direction for us all and some of which are pure quackery.

I stand by my conviction that physicians must embrace the role of guide for their patients. If we see ourselves only as instruments or tools in the service of the Government, the insurance companies or our healthcare organizations, patients are likely to mistrust our motives when we make diagnoses or recommend treatments.

On the other hand, if we work within the traditional healthcare system, we must strive to understand it well and present fairly the merits of the establishment’s usual approach to our patient’s problem. When our own educated opinion differs from mainstream medicine, it is our professional and ethical duty to tell our patients what we understand about their options and make it clear that this is not at this point in time the typical approach. I have done this for decades, warning patients that low fat diets promote heart disease by often inadvertently increasing intake of refined carbohydrates and telling patients that a Mediterranean diet has been shown to reduce heart attack risk at least as much as statin drug therapy. Medicine has always been an evolving science and to think it won’t continue to change is naive.

But if we disagree with everything conventional medicine does, we need to follow our conviction and move outside the system. If we do, we could be throwing the baby out with the bath water. And we could confuse and jeopardize patients by not informing them plainly enough that we aim to withhold accepted therapy because of our own dogmatism.

Our duty as guides is to walk with our patients in the direction they wish to go and to know more than one way of getting there; some people want the scenic route, others the fastest – some patients want better health with fewer medications and some want every intervention they can get.

It isn’t professional to only offer one approach if you know several. Let the patient choose.

Hans Duvefelt is a Swedish-born rural Family Physician in Maine. This post originally appeared on his blog, A Country Doctor Writes, here.