This is a very long article which I've scanned but will be reading with interest tomorrow.
The concluding analogy is one most of us will recognise with sinking hearts:
"The changing role of the physician in an increasingly bureaucratized medical care system
How do you feel when you go into a grocery store and find that one of your favorite products is no longer being stocked, even though you bought it every week for months? This happens because a statistical analysis indicates, not so much that no one was buying the product, but that it is no longer cost-effective to keep the product on the shelves. In the new way of doing things, physicians (especially those working for large medical centers) have to behave like grocery stores, following strict guidelines meant to maximize the bottom line.
Physicians have traditionally been trained to give patients individualized treatment, based on diagnoses that include not only lab tests but consideration of clinical signs and symptoms, the (family) medical history, sometimes clever detective work and general knowledge of the patient as a person. However, in the name of cutting costs, their job has been increasingly restricted to following rigid, oversimplified rules that emphasize theoretical projected longevity over actual quality of life, in the name of "evidence-based medicine." This creates special problems for patients with conditions with variable manifestations, especially those which cause pain and disability, especially when the rules are derived from loosely adhered-to guidelines that were not developed with scientific rigor. This is not a system that will encourage patients to take optimal amounts of iodized salt, to avoid stimulants, to exercise moderately but not excessively even when overweight, to learn how to do thyroid self-exams and how to avoid perchlorates and bromine in their diets."