The Metamorphosis of American Medicine

A short description of the article by Alvan R. Feinstein

The late author, Alvan R. Feinstein, was the Professor of Medicine and Epidemiology at Yale University.

After reading the article, one cannot help but ponder if the NHS is undergoing the same "metamorphosis", especially over the 30 years or so, spanning 1982 - 2010, under the Conservatives led by Thatcher and Major, and subsequently the Labour government led by Blair, leading up to the Conservative/Liberal Democrat backed NHS Reform Bill, passed in 2012.

In his scholarly paper entitled "The Metamorphosis of American Medicine", he describes the journey taken by the American healthcare system over 50 years (from 1948 to 1998), as it evolves from a caring profession to a business, and how doctors traded their professionalism for commerce.

He also detailed the rise and effects of Health Maintenance Organisations (HMO), Corporate (For-Profit) Medical Groups and ultimately, as a physician himself, the self-inflicted wounds acquired by doctors in a world where medical care has become a commercial activity.

These include the loss of professional autonomy and the moral hazards that arise from commercialisation of healthcare provisions.

A glimpse of the future, not only for the NHS itself, but also for all the clinicians working in it.

(Clinicians working in the UK can access this paper using Athens credentials via the links on this page) 

"WHEN I ENTERED MEDICAL SCHOOL in 1948, specialization and group practice were developing rapidly, but most physicians were still solo practitioners, often maintaining their office in their home

As proprietors of this cottage industry, physicians were usually financially comfortable, but not rich. They were respected, often revered members of their community, making useful contributions to the health and lives of their patients

For most patients, the relationship with their doctor was mutually trusting and gratifying.

Five decades later, the medical profession has undergone changes much more drastic than the social transformation that raised physicians' incomes from relative poverty in the 19th century to modest affluence in the first half of the 20th (Starr 1982).

The changes of the past 50 years can be quickly summarized with the following three vignettes of conversation that might occur when someone met a doctor on a social occasion.

In 1957, the statement might be, "So you're a doctor. Hey doc, what do you think about this rash on my arm?"

In 1977, the speaker might say, "So you're a doctor. Where's your Porsche?"

In 1997, the comment might be, "So you're a doctor. Let me tell you what some damned doctor and health care plan did to my sister."

Why has this change occurred? How did medicine evolve from a caring profession to a business? And how and why did doctors trade their professionalism for commerce?

I shall try to answer those questions as an internist whose career allowed direct observation of the cited events.

First Half of the..."

Alvan R. Feinstein

(Clinicians working in the UK can access the rest of this paper using Athens credentials via the links on this page)

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Page Updated: 27 May, 2017

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