Looking forward: the end of autonomy

Forecasting how medicine will be practiced 50 years from now presents a challenge. While advances in technology will have a major impact, new cultural outlooks on physician professionalism and autonomy will have an even greater significance in daily practice. The current healthcare system is in crisis. As members of a profession with responsibilities to both individual patients and society, all physicians have a duty to help solve the critical issues plaguing the healthcare system today. Solutions will require some major changes in the way physicians practice medicine. The most important--and the most difficult--change will be relinquishing our long-held belief in the premise of physician autonomy. As recognized in the Institute of Medicine's (IOM) Quality Chasm report, medicine today requires "more to know, more to do, more to manage, more to watch, and more people involved than ever before." Looking forward, these complexities will only intensify. To create the high-quality healthcare system of the future, the profession must discard its view of the physician as an independent, self-governing craftsman and adopt practices that are consistent with the principles of evidence-based medicine, continuous quality improvement (CQI), and transparency.