Your doctor is a puppet on strings to one degree or another. It may surprise you to learn the identity of one of the puppeteers.

The doctor-patient relationship is really a “duonomy”, or an “oligonomy”. The suffix “nomos” means law, and as you know, “autos” means self – these are both Greek words. The physician is not really a law unto himself. The patient is there, “ruling” with him – the rule of two or the rule of a few (the insurance company unfortunately has some input in most of these interactions) .

Richard Amerling of the Association of American Physicians and Surgeons has written a piece entitled ObamaCare: The Threat to Physician Autonomy.

The debate raging over ObamaCare has been carried on mostly by politicians, pundits, policy wonks and economists, with little input from those most intimately involved with delivery of health care—medical practitioners. Doctors have too often been marginalized as self-interested. If that were true, there would be far fewer practicing physicians.

We often think of the government and policy crafters as being those who attack and undermine doctor autonomy. One of the most insidious attacks on autonomy comes from an unlikely source – organizations that claim to have physician interests at heart:

For the past couple of decades medical specialty societies, aided and abetted by the government, the American Medical Association, and Big Pharma, have been crafting clinical practice guidelines. These mostly opinion based recommendations will be transformed into mandates, first as “clinical performance measures,” then as “payment for performance.”

As the doctor-patient relationship is a “rule by two”, established to accomplish health-related goals, your doctor needs your support and effort to assert his right to treat you as an individual.

Erosion of physician autonomy and the doctor-patient relationship is more subtle than “public options” and “death panels”. Not all the strings can be cut by all doctors, but you should at least be aware of who’s doing the pulling.