One can argue what was the most damaging aspect of the COVID-19 pandemic. Was it lives lost from the virus itself, damage to the economy, loss of civil liberties? I submit that it was the final straw that broke trust in medicine. 

Today’s physician, with all of the most sophisticated tools at hand, is simply building on the legacy of the earliest healers. Healers whose practice was based on their powers of observation and familiarity with the natural world, coupled with an intuitive recognition of cause and effect. Although separated by a vast gulf of knowledge and technology, both share one foundational thing—trust.  

Nowhere but in medicine do people consciously and voluntarily place their health and life so directly and completely in the hands of a total stranger. This requires a degree of trust unheard of in any other human interaction. Some say that airline pilots should rate above physicians because pilots may be responsible for hundreds of lives at one time, trusting the pilot to get them safely from point A to point B. There is no comparison. Passengers do not enter a commercial aircraft with their mortality staring them in the face or in sometimes terrifying circumstances. The pilot does not look each passenger in the face, get to know them personally, and tell them, “I will get you through this.” To both pilots and passengers, death and infirmity are an abstraction. Not so in medicine where they are very real.  

That this degree of trust exists in medicine is due to the history and heritage of our profession. Patients must trust that their physician is properly trained, competent, and practices with their best interest first and foremost.

This trust includes the conviction that the physician will provide them with the best care possible regardless of any extenuating circumstances.

These include life choices by patients that have led to their condition, financial status, insurance – or lack thereof, social status, and such immutable factors as race, ethnicity, and gender. Patients also trust that their unique circumstances and individuality will be taken into account and respected. They will not be regarded as simply an abstract member of a group, such as passengers in a plane or members of a particular race or culture. In the vast majority of cases, this trust is justified. 

Such trust is not unusual or remarkable; it is the way medicine has been practiced since time immemorial. No longer. There have been a number of fundamental changes to medical practice. The shift has been gradual until recently when it was exponentially accelerated by the COVID-19 pandemic. 

One gradual change has been the shift from independent medical practice to corporate medicine. The paradigm of the physician who completes his or her training, becomes board certified in a specialty, and opens a private practice is rapidly disappearing. In 2020, a survey by the American Medical Association found that – for the first time – fewer than 50% of physicians were in independent private practice. The sense of ownership of one’s practice and intimate personal responsibility for one’s patients is now largely gone. Continuity of care by one physician has been replaced by care by a large group in which physicians are infinitely interchangeable and, in some cases, can even be replaced by non-physicians.

Corporate physicians, like other employees, work regular hours, have scheduled time off, paid vacations, funded retirement plans, and no responsibility for running a practice, such as selecting and overseeing their office staff.

Corporate takeover of medicine, although paying lip service to quality, puts profitability front and center. Doctors are paid based on meeting productivity metrics, such as how many patients they see in a day. Most corporate measures of quality are based on patient reviews, such as Press Ganey Scores, which are little more than patient satisfaction surveys and are not a reliable measure of quality of care.   

The second big shift is the rise of mid-level medical personnel with limited training who have come to be regarded as equivalent to physicians. They are nurse practitioners and physician assistants. Although originally intended to work under a physician’s supervision, many have, over time, convinced themselves that they can provide the same medical care as a physician by virtue of their on-the-job training on top of their limited education, nearly all of which is didactic and sometimes virtual. A better example of the Dunning-Kruger Effect (a cognitive bias whereby people with low ability, expertise, or experience regarding a certain type of task or area of knowledge tend to overestimate their ability or knowledge) cannot be found. Many nurse practitioners enter clinical practice never having treated a patient in real life. Many patients do not know if their “provider” is a physician or not, as many mid-levels, while not explicitly claiming to be doctors, do not correct patients who call them by that title. 

Third is the politicization of medicine. Medicine has shifted from an objective, evidence-based, rigorously scientific and non-partisan profession to an ideologically driven one bent on social justice and furthering a pre-determined narrative. 

Take the COVID-19 lockdowns, for example. A few high-level bureaucrats, physicians all, with no background in public health policy or epidemiology took it upon themselves to abandon generations of experience with pandemics and followed lockstep behind the Chinese Communist Party in shutting down the economy and prohibiting normal social interactions. Public and private gatherings were prohibited. Novel measures like universal masking and “social distancing” replaced established pandemic policies. 

Dissenting voices from experts with actual experience in public policy and epidemiology were dismissed. Unprecedented, unconstitutional, and arguably illegal government mandates to take experimental vaccines were issued in order to work, travel, or simply live life normally. Countless first responders and health care providers who had worked through the pandemic lost their jobs because they refused novel vaccines. Inexplicably, the role of natural immunity, which was soon proven to be better than any vaccine, was completely ignored. All of this was done to achieve zero Covid although it was recognized early that this was not ever possible. 

A small cabal led by Dr. Anthony Fauci treated the pandemic with a one-size-fits-all approach even though we knew that Covid was uniquely benign to children and young adults and a thousand times more dangerous for the very elderly and those with certain conditions, such as obesity or diabetes. The relentless fear-mongering regarding COVID continues to this day with the CDC still bizarrely pushing bivalent boosters – even for young children, with essentially no data stating benefits of said boosters. 

Finally, ideology has infiltrated medicine within many institutions, from medical schools to professional organizations. The American College of Surgeons (ACS), which I belong to, has taken the position that it is systemically racist. The claim has been made, without evidence, that patients fare better when cared for by doctors of their own race or ethnicity. I cannot imagine a claim more destructive to trust then this. When I voiced my objection to this unfounded claim on the online discussion forum of the ACS, I was permanently banned from ever participating on that forum again. 

I think the final straw for me was the rush in medicine to embrace the issue of gender confusion. Human history, medical science and common sense have been thrown out the window to question the medical fact that there are two sexes.

The American Medical Association has endorsed eliminating sex determination from birth certificates because someone could be harmed later by this and people should be free to choose from over 70 “genders” and counting. I cannot even wrap my mind around this. How do you trust doctors who deny biological binary sex and cannot even define what a woman is? Gender affirmation therapy in children and adolescents, which includes puberty blocking drugs, cross sex hormones, and even surgery to remove normal breasts and penises in teenagers has permanently harmed thousands of confused adolescents and provoked a growing swell of pushback.

After 45 years as a physician, the state of medicine today breaks my heart. I no longer trust our medical institutions to provide reliable, trustworthy information or work in the best interests of patients. With a few like-minded colleagues we have resolved to do what we can to restore this lost trust.