Separation and Globalization

The "Brexit" movement is fascinating to me because of some parallels with the medical world. Those who voted for Britain to leave the European Union were mostly older (59% of those 65+ voted to leave compared to 19% of those 18-24), who experienced England before the E.U., who were hurt by globalization. I don't pretend to understand the complex political milieu, but I sense parallels in medicine. There is a globalization of medicine that has been occurring and will continue to change the way we practice. Several generations ago, in a simpler time, medicine was provided by independent individual practitioners. The physician made all the decisions unfettered by the wants, desires, influences, and decrees of other entities. Over time though, more and more of medicine is being structured. We have coalesced into groups that standardize care. Hospitals introduce protocols and pathways to reduce variability. Insurance companies limit the medications we can prescribe. Consumers rate us on how we're doing. We make fewer free decisions. And in return (or perhaps this takes the analogy too far), doctors, hospitals, and health care institutions develop a common language, a shared set of expectations, and better cross-talk and communication. A lot of older practitioners don't like this; "we know better," they think (and they certainly might). But the newly minted physicians, used to this, appreciate the advantages of common standards and practices. We don't want to separate. We like globalization. And we see it to be the future; the world is more and more interconnected. There are fewer pockets of local isolation and provincialism. To practice medicine, we must meet a global standard. We don't discount that history and legacy that got us here; we look forward to see where things are going.