We have recently opined on the social distortion of medical practice in Australasia. First, we argued that society had been extensively medicalized. This was an extension of Ivan Illich's hypothesis of iatrogenesis and is supported by the low likelihood of common symptoms reported in primary care settings being shown to exist because of somatic disease. Second, we claimed that medicine had been extensively socialized and that doctors, especially in primary care, were strongly influenced by social factors other than the best health interests of their patients. This claim was based on work underway in our department and on social histories of medicine such as David Lifton's description of practice drift among German doctors under the Third Reich and the late Roy Porter's history of medicine. The basic concept here is that only a guild model can adequately explain the 3000-plus year history of the medical profession and that the primary pursuit of any guild is its own best interests. In part, the medical guild protects itself by controlling the training of would be and current doctors. Many would support this as a proper response to the Hippocratic tradition.5 We did not elaborate on these educational issues; however, we urgently need to confront two related and worsening dilemmas for medical educators. It is also clear from recent Government interventions on both sides of the Tasman sea that any sensible initiative will need to come from elsewhere. The first dilemma relates to the health system that is best suited to the social need in the year 2020.
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