De Leeuw raises an important issue, namely accreditation of medical programmes, and its impact on the future of medical practitioners in particular and medicine at large. One cannot help but agree with the general observations put into focus in this paper. However, I would suggest, there are important other issues that maintain the current status-quo of the healthcare professions (the pleural is intended as other healthcare disciplines are equally affected).
The Underpinnings of Health Care Make Health Care a Social Endeavor
The notion that the medical professions are grounded in sound social and philosophical commitments to human well-being and advancement is the very foundation of medicine since time in memoriam (Illich, 1976; Pellegrino & Thomasma, 1981; Sturmberg, 2007). It should not be frowned upon, rather it should be the starting point of re-thinking the purpose, meaning and operation of caring. Caring in fact should be the imperative work since most patients we care for have no medical condition explainable by the mechanistic biomedical model (Green, Fryer, Yawn, Lanier, & Dovey, 2001; White, Williams, & Greenberg, 1961). These studies show that the epidemiology of health, illness, dis-ease and disease in the community follows a Pareto distribution (Figure 1), with only a minor percentage requiring tertiary hospital medicine (Sturmberg, O’Halloran, & Martin, 2011). A point important to take into consideration when thinking about health professionals’ education.
Given the needs of the people to address their subjective wellbeing of health, illness and dis-ease rather than merely an underlying less frequent disease (Lewis, 2003; Sturmberg et al., 2011), humanities should rightly be the driver of the healthcare system (Sturmberg, Martin, & Moes, 2010; Sturmberg, O’Halloran, & Martin, 2010). We tend to talk about systems in a very loose way, and approach system change with an unshakable cause-and-effect mindset, a fatal mistake. Systems not only consist of many interconnected agents acting in nonlinear (and non deterministic) ways, it also entails that their configuration and dynamics are governed by a common goal, a core driver. It is this core driver that ultimately “determines” the fate of any system (Cilliers, 1998).