Prescription for an Ailing Profession

...At present, with a broader curriculum and a tremendous body of knowledge to be absorbed, the complaint carries additional weight...

...The economic and academic necessities accompanying that triumph, however, altered the whole medical care structure in the country...

...Despite countless billions of dollars spent, he observes, no medical discovery of the past 30 years has in fact equaled that of antibiotics in the 1930s and 1940s or the polio vaccine of the 1950s...

...The last— the elusive ideal of medical education— is termed the key to understanding the emergence of today's intricate medical system and ultimately to maximizing its potential...

...The book's concluding chapters in particular discuss critical questions related to producing competent and caring physicians in an era when technology is gaining a life of its own and "more" seems always to be better...

...As early as 1910, when Abraham Flexner published his famous report on "Medical Education in the United States and Canada," the "academic model" of inquiry devised by German-influenced American physicians and embraced by the general public positioned medical schools and teaching hospitals as the primary sites for medical investigation...

...Alliances were forged among medical schools, hospitals, universities, philanthropists, and finally the government...

...Professional reputation became largely a matter of academic accomplishment...

...Thus, while headlines almost daily herald the dramatic medical and scientific advances in this country, they also curse a system so complex, so expensive and so impersonal that government and individuals alike are battling, in Congress and in the courts, to regain some control...

...Learning to Heal is chock-full of anecdotal information that will intrigue medical school alumni, trivia mavens and history buffs...

...We are all too familiar with the image of the exhausted young intern functioning on auto-pilot, and the practicing physician who understands the body's organs yet has lost the human touch...

...Full-time clinical professors assumed control, making teaching hospitals the centers of modern clinical training and high-quality patient care...

...Reviewed by Sally J. Rogers Director of Communications, United Hospital Fund Americans are healthier and living longer than ever before...

...Medical students benefited, and suffered, from the turn of events...

...In 1925, Flexner expressed his concern about the demanding and sometimes demeaning methods of the educators: "A student sagging under such a burden cannot, except sporadically, stop to read, work, or think at random...

...Life expectancy is at a record high and infant mortality has reached an all-time low...

...In his meticulously researched and fascinating new book, Learning to Heal, Kenneth Ludmerer offers valuable insights into the broad ethical, economic and social questions currently facing ourmedical establishment...

...They ensured the expansion of medicine's traditional humanitarian purpose to include educational and scientific aims that would both enhance and compromise care, and result in insatiable demands for funding...

...The understanding Ludmerer provides could be the basis for evolving a more rational medical system that would combine cost efficiency—amid justified large expenses— with a genuine concern for offering the best patienl carc...

...All the successes and failures apparent to us now, Ludmerer maintains, are legacies of those 50 years when proprietary schools, graduating physicians with virtually no knowledge of the basic sciences, gave way to an enterprise nurtured by the great universities of Germany and the rest of Europe and built on laboratory investigation, clinical training and critical thinking...

...Essentially, though, the book is a thoughtful exploration of how all our good work has created moral and practical dilemmas as well as continually escalating expectations...

...Early in the process traditional medical practitioners lost their influence within the profession, although they gained power and status outside...

...not "What is there to do...

...A radical departure from rote memorization, it was intended to foster a student's ability to think creatively, to solve problems, to acquire new information, and to keep up with changing times...

...Indeed, the Flexner report— which Ludmerer seems intent on deflating, except to acknowledge that it galvanized public opinion—led to tremendous interest in and new-found support for medical schools...

...The impact of the germ theory of disease and the emergence of modern bacteriology, immunology and other advances are chronicled in some detail...

...medical education was on firm financial footing...

...Such critical thinking is clearly framed by the author as the only defense against a setup that is generating frightening costs and subjecting patients to greater risks and discomfort...

...These noble (and still not totally fulfilled) objectives laid the foundation for America's medical miracles, but they also inspired the "corporatization" of American medicine, with all of its high costs and convoluted relationships...

...The premise of the modern approach —"educating the eye to see, the ear to hear and the finger to feel"—was put forward in the late 1800s by William Osier of Johns Hopkins, whom Ludmerer calls the greatest American clinical teacher of all time...

...It leads the reader along a rapid trail of change and makes sense of the positive and negative aspects of the big medical business we have fashioned...

...Hedoesthis by tracking the development of medical education in the United States during the half century—from the 1880stothe 1930s—that transformed American medicine...

...Recalling the philosophy of medical education developed over a century ago, Ludmerer emphasizes its ever growing importance today for turning out doctors who ask "Should it be done...

...Throughout his social, political and economic treatise, Ludmerer grapples with vital ethical problems and looks to the future of American medical education...

...Ludmerer notes that these scientific leaps alone did more to change American medicine than any new teaching methodologies or infusions of financial support...

...Leadership in scientific and educational areas was seized by a medical establishment that controlled entrance to medical schools, shaped the curriculum, and dictated "standard medical practice...

...He postulates that some of the worry the American public has today about health care costs is related to the question of whether the investment being made in medical research is yielding an appropriate return...

...More than 10 per cent of the nation's gross national product is expended on health care, with the cost per capita reaching $1,580 in 1984, three times the amount spent 10 years earlier...

...Ludmerer describes at length how medicine took on its corporate form...

...Glimpses into the history of science constitute an illuminating backdrop to this story of institution-building, and raise another set of issues...

...But gains in the nation's health have not come cheaply...

...By the 1930s, U.S...