Physicians are notoriously self-involved. This country's traditional medical culture reinforces narcissism and competitiveness in its members, almost from the first day of pre-medical training. While being concerned for one's own personal well-being is a natural human trait, when taken to extremes it can produce a great deal of disharmony. In the case of our own profession, overemphasis on the physician as the center of her own universe has led to some of the unnecessarily brutal aspects of medical training in this country. It also explains why our profession, more than any other allied health profession, is struggling enormously in the face of a changing American health care system.

Many doctors in this country still operate as if it's 1970-something, and each doctor is his own corporation: “I am Dr. Bob Jones, Inc.” At most, they might conceive of themselves as part of a small group of affiliated fellow physicians. This fails to face up to reality: To managed care and to integrated health systems, we are widgets – cogs in their machines. The fact that I, Dr. Bob Jones, am especially skilled in taking care of older patients, or catching tricky diagnoses, or working with depressed patients, or whatever – whatever individual skills I've cultivated in myself in which I take great pride – is totally invisible to the health care corporations.

American doctors persist in the delusion of themselves as individual corporate entities.