Medicine, Its Practice, 1971

In the June 1971 edition of NEJM there was an article regarding the changing practice of medicine. I thought it would be of interest to provide the first paragraph of the abstract,

The Social legislation of 1965–66 represented a post-war II adjustment with a shift in ethics from individualism in an agrarian society to a complex organization in a dominantly urban society. Consequently, a reformation in health services confronts physicians, who have long enjoyed a respected position in providing care for those who assumed personal responsibility. Now that society has assumed responsibility, proof of competence is demanded from the physician receiving payment for service. Thus, unless present methods of continuing education are strengthened, government threatens to control their accreditation and to demand licensure of physicians based on periodic re-examination.

Two points worth noting.

1. Individualism: Before the Johnson era social programs the individual brought a certain level of personal responsibility to the table. The patient coming in who had been bleeding in their urine for several months often was chided for not coming in sooner. The patient had to take some blame, for obesity, drinking, drug abuse, risky sexual activity and the like.

2. The phrase, "now that society has assumed responsibility" is the most telling, for under the period of Johnson the government, read society, took over, for better or worse, and that is when school lunches, a good intention, exploded, as did the caloric intake. Unintended consequences, loss of individualism, and making everything that goes wrong a disease.

Interesting to see what things were like 40 years ago.