Zen and the Art of Physician Autonomy Maintenance

17 June 2003 | Volume 138 Issue 12 | Pages 992-995

The miracles of scientific medicine propelled physicians to an unparalleled level of clinical autonomy during the 20th century. During the past 20 years, physician autonomy has been declining, in part because the public has become aware that physicians are not consistently applying all of the science they know. One of medicine's most cherished professional values, individual clinical autonomy, is an important cause of the sometimes suboptimal performance in the timely and consistent application of clinical science; thus, it contributes to the decline in overall professional autonomy. This paper calls for physicians to practice the science of medicine as a profession so that society will allow physicians to continue practicing the art of medicine as individual professionals. In a Zen-like paradox, physicians must give up autonomy in order to regain it.

Author and Article Information

From Institute for Healthcare Improvement, Boston, Massachusetts.

Acknowledgments: The author thanks Frank Davidoff, MD; Sir Brian Jarman, OBE, MA, PhD; and Richard LeBlond, MD, for their helpful critical reviews of this article.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: James L. Reinertsen, MD, 375 East Aspen Meadow Lane, Alta, WY 83414; e-mail, reinertsen{at}att.net.