Dear Editor
I thank Dr. Heath and Dr. Montori from the bottom of my heart for writing this essay. They have expressed the inexpressible about what gives my own work as a general practitioner meaning in the face of the industrialization of medicine and what keeps me going even in the face of the mounting forces of this industrialization. The crisis they so articuately and beautifully desribe is not unique to health care in the UK and the US. The same forces are at work here in Canada and, I suspect, in most high income countries.
Not all physicians may feel this way about such forces and how they are transforming our work. Many see it as progress and some are even involved in profiting from these forces.
One of the many touchstone essays for me throughout my career has been Gayle Stephens “Family Medicine as Counterculture” based on lecture he gave in the late 1970s. The cultural forces that have been shaping medicine and the larger society since Dr. Stephens gave that lecture are capilaist, market forces. Indeed, political philosopher Michael Sandel has persuasively argued that over the past four decades we have moved from a market economy to a market society and has catalogued the corrupting effect of this on public institutions and the common good.
Your essay is, to my mind, part of that proud counter-cultural tradition of general practice. I will be sharing this widely with colleagues, students, friends and family – anyone who values what I have valued about caring for people as a physician these past three decades.