Physician Sovereignty: The Dangerous Persistence of an Obsolete Idea

David Lawrence

Policy brief no. 40


Since the publication of the landmark Institute of Medicine studies in 1999 and 2001 that called for care integration, better organization of care, team-based care, and implementation of best practices for safety, my impression is that, if anything, safety has deteriorated because the pace of scientific and technological innovation has outstripped the ability of institutions to keep pace. More and more powerful tools are invented every day—Lourie Lecture Policy Brief therapeutics, diagnostics, surgical interventions—but the systems to incorporate them safely remain primitive. Another example. In 2003, a RAND-UCLA study reported that patients get scientifically appropriate care just over 50% of the time in ambulatory settings. Why? Why is the system so resistant to change? Why do innovations diffuse so slowly and unevenly into the care system? This is the question I’d like to address today