Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0009
- Subject:
- History, American History: 20th Century
The expansion of clinical service in the two decades following World War II created strains within academic medical centers, largely because of the distractions that patient care inevitably placed on ...
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The expansion of clinical service in the two decades following World War II created strains within academic medical centers, largely because of the distractions that patient care inevitably placed on teaching and research. Nevertheless, few academic medical centers lost sight—at least for long—of their unique role as educators of future physicians, and as producers of new medical knowledge and technologies. They worked hard to preserve the learning environment of the teaching hospital, even as that environment came under pressure from changing social, economic, and demographic circumstances. After the war, the strength of American medicine continued to reside in its academic medical centers—the collaborations of medical schools and teaching hospitals that generated knowledge, produced doctors, served as the ultimate arbiters in complicated clinical cases, and defined the standards of excellence in patient care.Less
The expansion of clinical service in the two decades following World War II created strains within academic medical centers, largely because of the distractions that patient care inevitably placed on teaching and research. Nevertheless, few academic medical centers lost sight—at least for long—of their unique role as educators of future physicians, and as producers of new medical knowledge and technologies. They worked hard to preserve the learning environment of the teaching hospital, even as that environment came under pressure from changing social, economic, and demographic circumstances. After the war, the strength of American medicine continued to reside in its academic medical centers—the collaborations of medical schools and teaching hospitals that generated knowledge, produced doctors, served as the ultimate arbiters in complicated clinical cases, and defined the standards of excellence in patient care.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0005
- Subject:
- History, American History: 20th Century
After World War I, teaching hospitals championed the same academic ideals as their affiliated medical schools, and the two institutions acted in concert in education, research, and patient care. The ...
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After World War I, teaching hospitals championed the same academic ideals as their affiliated medical schools, and the two institutions acted in concert in education, research, and patient care. The relationship between medical schools and teaching hospitals was one of codependency. Medical schools, ever on the alert for clinical facilities, understood that access to the wards of hospitals was essential for teaching and research. Teaching hospitals, in turn, understood that their preeminence in 20th-century medical practice was a consequence of their participation in medical education. Though teaching hospitals of the period served as nearly ideal educational laboratories, this did not occur without costs or consequences. It quickly became apparent that teaching hospitals could not be as efficient as nonteaching hospitals, if at the same time they were providing a rich educational environment. In addition, the fact that indigent but not private patients were routinely used in teaching challenged the common belief that medical education resulted in better patient care.Less
After World War I, teaching hospitals championed the same academic ideals as their affiliated medical schools, and the two institutions acted in concert in education, research, and patient care. The relationship between medical schools and teaching hospitals was one of codependency. Medical schools, ever on the alert for clinical facilities, understood that access to the wards of hospitals was essential for teaching and research. Teaching hospitals, in turn, understood that their preeminence in 20th-century medical practice was a consequence of their participation in medical education. Though teaching hospitals of the period served as nearly ideal educational laboratories, this did not occur without costs or consequences. It quickly became apparent that teaching hospitals could not be as efficient as nonteaching hospitals, if at the same time they were providing a rich educational environment. In addition, the fact that indigent but not private patients were routinely used in teaching challenged the common belief that medical education resulted in better patient care.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0014
- Subject:
- History, American History: 20th Century
Domestic tranquility returned quickly to the United States with the end of the Vietnam War. Nevertheless, in the 1970s and 1980s, academic health centers came under new external pressures. Other ...
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Domestic tranquility returned quickly to the United States with the end of the Vietnam War. Nevertheless, in the 1970s and 1980s, academic health centers came under new external pressures. Other aspects of the outside environment began to turn sour, as social and demographic trends, new government policies, and changing public attitudes started to work to their disadvantage. Medical schools and teaching hospitals were increasingly perceived as stressed institutions, and a dispirited mood developed among them. Their confidence and sense of autonomy, so prominent before World War II and during the mythic “golden age” of the 1950s and 1960s, dwindled. Always dependent upon external funding, medical schools had never been as truly autonomous as it once seemed. Nevertheless, it now appeared that they were vulnerable to every jolt on an increasingly bumpy road.Less
Domestic tranquility returned quickly to the United States with the end of the Vietnam War. Nevertheless, in the 1970s and 1980s, academic health centers came under new external pressures. Other aspects of the outside environment began to turn sour, as social and demographic trends, new government policies, and changing public attitudes started to work to their disadvantage. Medical schools and teaching hospitals were increasingly perceived as stressed institutions, and a dispirited mood developed among them. Their confidence and sense of autonomy, so prominent before World War II and during the mythic “golden age” of the 1950s and 1960s, dwindled. Always dependent upon external funding, medical schools had never been as truly autonomous as it once seemed. Nevertheless, it now appeared that they were vulnerable to every jolt on an increasingly bumpy road.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0006
- Subject:
- History, American History: 20th Century
Though medical schools and teaching hospitals were separate entities, they operated extremely closely, and their individual successes depended very much on their collaboration. In the late 1920s, the ...
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Though medical schools and teaching hospitals were separate entities, they operated extremely closely, and their individual successes depended very much on their collaboration. In the late 1920s, the term “medical center” came into use to describe arrangements in which a medical school and teaching hospital occupied adjoining physical sites. The term was first used in conjunction with the opening of the Columbia Presbyterian Medical Center in 1928 and the New York Hospital–Cornell Medical Center in 1932. After World War II these complexes came to be called “academic medical centers.” Though no two were exactly alike, the centers typically consisted of a medical school, a university-owned or controlled hospital, and affiliated specialty hospitals or institutes. Academic medical centers were at the center of efforts to improve the quality of medical care and the health of the people, thus rendering service to the nation at large. In short, academic medical centers, like their parent universities, accepted the duty of utility—that is, of providing service to the society that supported them, and allowed them to pursue their scientific interests.Less
Though medical schools and teaching hospitals were separate entities, they operated extremely closely, and their individual successes depended very much on their collaboration. In the late 1920s, the term “medical center” came into use to describe arrangements in which a medical school and teaching hospital occupied adjoining physical sites. The term was first used in conjunction with the opening of the Columbia Presbyterian Medical Center in 1928 and the New York Hospital–Cornell Medical Center in 1932. After World War II these complexes came to be called “academic medical centers.” Though no two were exactly alike, the centers typically consisted of a medical school, a university-owned or controlled hospital, and affiliated specialty hospitals or institutes. Academic medical centers were at the center of efforts to improve the quality of medical care and the health of the people, thus rendering service to the nation at large. In short, academic medical centers, like their parent universities, accepted the duty of utility—that is, of providing service to the society that supported them, and allowed them to pursue their scientific interests.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0010
- Subject:
- History, American History: 20th Century
The explosion of knowledge in all academic disciplines after World War II shattered traditional approaches toward scholarship. Fragmentation of disciplines and academic specialization occurred ...
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The explosion of knowledge in all academic disciplines after World War II shattered traditional approaches toward scholarship. Fragmentation of disciplines and academic specialization occurred throughout universities. In medicine, a similar fragmentation of knowledge and practice occurred. The movement toward specialization had been underway for many decades, but as biomedical research progressed, the growth of specialization and subspecialization rapidly accelerated. Though general practice did not disappear after World War II, its attractiveness as a career to physicians in training markedly decreased. Following internship, more and more medical graduates sought residencies to pursue a specialty, and after residency, many sought postdoctoral training in a clinical subspecialty as well. Teaching hospitals quickly met the increased demand for specialty training. Graduate medical education, once only a secondary interest of medical faculties, became one of their primary concerns. At many medical centers, the number of interns, residents, subspecialty residents, and clinical fellows grew to exceed the number of medical students. As the multiversity began to swell with graduate student training programs, the postwar academic medical center became home to a vastly expanded program of graduate medical education.Less
The explosion of knowledge in all academic disciplines after World War II shattered traditional approaches toward scholarship. Fragmentation of disciplines and academic specialization occurred throughout universities. In medicine, a similar fragmentation of knowledge and practice occurred. The movement toward specialization had been underway for many decades, but as biomedical research progressed, the growth of specialization and subspecialization rapidly accelerated. Though general practice did not disappear after World War II, its attractiveness as a career to physicians in training markedly decreased. Following internship, more and more medical graduates sought residencies to pursue a specialty, and after residency, many sought postdoctoral training in a clinical subspecialty as well. Teaching hospitals quickly met the increased demand for specialty training. Graduate medical education, once only a secondary interest of medical faculties, became one of their primary concerns. At many medical centers, the number of interns, residents, subspecialty residents, and clinical fellows grew to exceed the number of medical students. As the multiversity began to swell with graduate student training programs, the postwar academic medical center became home to a vastly expanded program of graduate medical education.
Muriel R. Gillick M.D.
- Published in print:
- 2017
- Published Online:
- May 2018
- ISBN:
- 9781469635248
- eISBN:
- 9781469635255
- Item type:
- chapter
- Publisher:
- University of North Carolina Press
- DOI:
- 10.5149/northcarolina/9781469635248.003.0006
- Subject:
- Palliative Care, Palliative Medicine and Older People
American hospitals come in a variety of flavors: teaching and non-teaching, for profit and not-for-profit, large and small, government and private, urban and rural. While the patient’s experience ...
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American hospitals come in a variety of flavors: teaching and non-teaching, for profit and not-for-profit, large and small, government and private, urban and rural. While the patient’s experience varies slightly depending on the type of hospital, all hospitals could be improved to better serve the needs of older patients if they implemented basic geriatric principles.Less
American hospitals come in a variety of flavors: teaching and non-teaching, for profit and not-for-profit, large and small, government and private, urban and rural. While the patient’s experience varies slightly depending on the type of hospital, all hospitals could be improved to better serve the needs of older patients if they implemented basic geriatric principles.
Antonio M. Gotto and Jennifer Moon
- Published in print:
- 2016
- Published Online:
- August 2016
- ISBN:
- 9781501702136
- eISBN:
- 9781501703676
- Item type:
- chapter
- Publisher:
- Cornell University Press
- DOI:
- 10.7591/cornell/9781501702136.003.0006
- Subject:
- Education, Higher Education
This chapter studies how the passage of Medicare and Medicaid in 1965 brought new populations of poor and elderly patients to hospitals and clinics nationwide. Medical schools and teaching hospitals ...
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This chapter studies how the passage of Medicare and Medicaid in 1965 brought new populations of poor and elderly patients to hospitals and clinics nationwide. Medical schools and teaching hospitals became even more involved in addressing the health care needs of their surrounding communities. Since these shifts overlapped with the social activism of the 1960s, many medical students at Cornell became passionately engaged in outreach efforts to underserved patients. Faced with postwar inflation, hospitals focused on private patient admissions in order to increase revenue. Concerns were raised that the shift toward private patients would have a negative effect on teaching and research. In response, Dean John E. Deitrick proposed a system in which all fees obtained by patients would support the clinical faculty as a whole, and all patients would participate in teaching and research efforts.Less
This chapter studies how the passage of Medicare and Medicaid in 1965 brought new populations of poor and elderly patients to hospitals and clinics nationwide. Medical schools and teaching hospitals became even more involved in addressing the health care needs of their surrounding communities. Since these shifts overlapped with the social activism of the 1960s, many medical students at Cornell became passionately engaged in outreach efforts to underserved patients. Faced with postwar inflation, hospitals focused on private patient admissions in order to increase revenue. Concerns were raised that the shift toward private patients would have a negative effect on teaching and research. In response, Dean John E. Deitrick proposed a system in which all fees obtained by patients would support the clinical faculty as a whole, and all patients would participate in teaching and research efforts.
Kenneth M. Ludmerer
- Published in print:
- 2005
- Published Online:
- October 2011
- ISBN:
- 9780195181364
- eISBN:
- 9780199850167
- Item type:
- chapter
- Publisher:
- Oxford University Press
- DOI:
- 10.1093/acprof:oso/9780195181364.003.0016
- Subject:
- History, American History: 20th Century
In the 1970s and 1980s a distinct malaise pervaded many medical schools. As they increased their role in patient care, and as they grew ever larger in size, they struggled to maintain their ...
More
In the 1970s and 1980s a distinct malaise pervaded many medical schools. As they increased their role in patient care, and as they grew ever larger in size, they struggled to maintain their institutional cohesiveness and clear focus on academic work. In addition, medical schools, long a symbol of public service, began to appear self-serving and unconcerned with the public good. To many, the once-clear distinction between a university teaching hospital and a large community hospital began to blur, as did the formerly clear differences between a university medical school dedicated to serving the public and a scientific corporation seeking to maximize markets and profits.Less
In the 1970s and 1980s a distinct malaise pervaded many medical schools. As they increased their role in patient care, and as they grew ever larger in size, they struggled to maintain their institutional cohesiveness and clear focus on academic work. In addition, medical schools, long a symbol of public service, began to appear self-serving and unconcerned with the public good. To many, the once-clear distinction between a university teaching hospital and a large community hospital began to blur, as did the formerly clear differences between a university medical school dedicated to serving the public and a scientific corporation seeking to maximize markets and profits.
Jason R. Barro and Michael Chu (eds)
- Published in print:
- 2003
- Published Online:
- February 2013
- ISBN:
- 9780226297859
- eISBN:
- 9780226297866
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226297866.003.0004
- Subject:
- Economics and Finance, Financial Economics
This chapter examines the underlying cause of the rapid increase in hospital advertising in the United States. A critical component of the explanation is the rise of managed care across the country. ...
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This chapter examines the underlying cause of the rapid increase in hospital advertising in the United States. A critical component of the explanation is the rise of managed care across the country. In markets that experienced the greatest rise in managed care influence, large teaching hospitals had the most rapid increase in advertising. For all other hospitals, increased managed care reduced ad spending, suggesting that HMOs represent a financial shock to hospitals. The chapter is organized as follows. Section 3.2 discusses the history of hospital advertising and the economics behind advertising for hospitals. Section 3.3 presents various hypotheses as to why hospitals would have changed their advertising behavior at this time. Section 3.4 discusses the data; Section 3.5 presents the empirical results; and the final section concludes.Less
This chapter examines the underlying cause of the rapid increase in hospital advertising in the United States. A critical component of the explanation is the rise of managed care across the country. In markets that experienced the greatest rise in managed care influence, large teaching hospitals had the most rapid increase in advertising. For all other hospitals, increased managed care reduced ad spending, suggesting that HMOs represent a financial shock to hospitals. The chapter is organized as follows. Section 3.2 discusses the history of hospital advertising and the economics behind advertising for hospitals. Section 3.3 presents various hypotheses as to why hospitals would have changed their advertising behavior at this time. Section 3.4 discusses the data; Section 3.5 presents the empirical results; and the final section concludes.
Eli Ginzberg
- Published in print:
- 2000
- Published Online:
- October 2013
- ISBN:
- 9780300082326
- eISBN:
- 9780300133011
- Item type:
- book
- Publisher:
- Yale University Press
- DOI:
- 10.12987/yale/9780300082326.001.0001
- Subject:
- Sociology, Social Stratification, Inequality, and Mobility
Academic health centers (AHCs) have played a key role in propelling the United States to world leadership in technological advances in medicine. At the same time, however, many of these urban-based ...
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Academic health centers (AHCs) have played a key role in propelling the United States to world leadership in technological advances in medicine. At the same time, however, many of these urban-based hospitals have largely ignored the medical care of their poor neighbors. Now one of the leading experts in American health policy and economics ponders whether current and proposed changes in the financing and delivery of medical care will result in a realignment between AHCs and the poor. Basing the discussion on an analysis of the nation's twenty-five leading research-oriented health centers, this book traces the history of AHCs in the twentieth century. It claims that AHCs are once again moving toward treating the poor because these hospitals need to admit more Medicaid patients to fill their empty beds, and their medical students need opportunities to practice in ambulatory sites. It also assesses some of the more important trends that may challenge the AHCs, including financial concerns, changing medical practice environments, and the likelihood of some form of universal health insurance.Less
Academic health centers (AHCs) have played a key role in propelling the United States to world leadership in technological advances in medicine. At the same time, however, many of these urban-based hospitals have largely ignored the medical care of their poor neighbors. Now one of the leading experts in American health policy and economics ponders whether current and proposed changes in the financing and delivery of medical care will result in a realignment between AHCs and the poor. Basing the discussion on an analysis of the nation's twenty-five leading research-oriented health centers, this book traces the history of AHCs in the twentieth century. It claims that AHCs are once again moving toward treating the poor because these hospitals need to admit more Medicaid patients to fill their empty beds, and their medical students need opportunities to practice in ambulatory sites. It also assesses some of the more important trends that may challenge the AHCs, including financial concerns, changing medical practice environments, and the likelihood of some form of universal health insurance.
James Kelly
- Published in print:
- 2013
- Published Online:
- August 2016
- ISBN:
- 9780801451683
- eISBN:
- 9780801467653
- Item type:
- chapter
- Publisher:
- Cornell University Press
- DOI:
- 10.7591/cornell/9780801451683.003.0002
- Subject:
- Sociology, Occupations, Professions, and Work
In this chapter, the author reflects on the importance of diagnosis in medicine. He first describes almshouses that functioned like hospitals in America before citing one thing that makes the ...
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In this chapter, the author reflects on the importance of diagnosis in medicine. He first describes almshouses that functioned like hospitals in America before citing one thing that makes the intensive care unit (ICU): the drugs that are administered to patients. He then considers the views of doctors and patients regarding disease, suggesting that doctors are interested in disease rather than death. He also talks about the families of the patients, as well as medicine and how it wasn't always taught in the hospital. The author concludes by focusing on William Osler, founder of the teaching hospital and one of the four physicians who began Johns Hopkins Hospital.Less
In this chapter, the author reflects on the importance of diagnosis in medicine. He first describes almshouses that functioned like hospitals in America before citing one thing that makes the intensive care unit (ICU): the drugs that are administered to patients. He then considers the views of doctors and patients regarding disease, suggesting that doctors are interested in disease rather than death. He also talks about the families of the patients, as well as medicine and how it wasn't always taught in the hospital. The author concludes by focusing on William Osler, founder of the teaching hospital and one of the four physicians who began Johns Hopkins Hospital.
James Kelly
- Published in print:
- 2013
- Published Online:
- August 2016
- ISBN:
- 9780801451683
- eISBN:
- 9780801467653
- Item type:
- chapter
- Publisher:
- Cornell University Press
- DOI:
- 10.7591/cornell/9780801451683.003.0001
- Subject:
- Sociology, Occupations, Professions, and Work
In this chapter, the author reflects on the daily and hourly activities of the doctors and nurses in the intensive care unit (ICU) where he works. He describes the ICU as pure medicine and a nursing ...
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In this chapter, the author reflects on the daily and hourly activities of the doctors and nurses in the intensive care unit (ICU) where he works. He describes the ICU as pure medicine and a nursing world and the patient as a network of nine systems: neurologic, cardiovascular, pulmonary, gastrointestinal, genitourinary, renal, integumentary, hematologic, and endocrine. He also considers the principle of the ICU: single-organ-directed interventions to support failing organ systems. He suggests that the teaching hospital is a kind of workshop that makes doctors, where they are put together, assembled, polished, made sure they are in working order, put through tests to make sure they are up to it. Finally, he talks about fourteen patients at the hospital and their various illnesses.Less
In this chapter, the author reflects on the daily and hourly activities of the doctors and nurses in the intensive care unit (ICU) where he works. He describes the ICU as pure medicine and a nursing world and the patient as a network of nine systems: neurologic, cardiovascular, pulmonary, gastrointestinal, genitourinary, renal, integumentary, hematologic, and endocrine. He also considers the principle of the ICU: single-organ-directed interventions to support failing organ systems. He suggests that the teaching hospital is a kind of workshop that makes doctors, where they are put together, assembled, polished, made sure they are in working order, put through tests to make sure they are up to it. Finally, he talks about fourteen patients at the hospital and their various illnesses.
James Kelly
- Published in print:
- 2013
- Published Online:
- August 2016
- ISBN:
- 9780801451683
- eISBN:
- 9780801467653
- Item type:
- book
- Publisher:
- Cornell University Press
- DOI:
- 10.7591/cornell/9780801451683.001.0001
- Subject:
- Sociology, Occupations, Professions, and Work
This book is a nonfiction narrative grounded in the day-by-day, hour-by-hour rhythms of an intensive care unit (ICU) in a teaching hospital in the heart of New Mexico. It takes place over a ...
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This book is a nonfiction narrative grounded in the day-by-day, hour-by-hour rhythms of an intensive care unit (ICU) in a teaching hospital in the heart of New Mexico. It takes place over a thirteen-week period, the time of the average rotation of residents through the ICU. It is the story of patients and families, suddenly faced with critical illness, who find themselves in the ICU. The book describes how they navigate through it and find their way, acting as a sensitive witness to the quiet courage and resourcefulness of ordinary people. The book leads the reader into a parallel world: the world of illness. This world, invisible but not hidden, not articulated by but known by the ill, does not readily offer itself to our understanding. In this context, the book reflects on the nature of medicine and nursing, on how doctors and nurses see themselves and how they see each other. Drawing on the words of medical historians, doctor-writers, and nursing scholars, the book examines the relationship of professional and lay observers to the meaning of illness, empathy, caring, and the silence of suffering. In doing so, the book offers up an intimate portrait of the ICU and its inhabitants.Less
This book is a nonfiction narrative grounded in the day-by-day, hour-by-hour rhythms of an intensive care unit (ICU) in a teaching hospital in the heart of New Mexico. It takes place over a thirteen-week period, the time of the average rotation of residents through the ICU. It is the story of patients and families, suddenly faced with critical illness, who find themselves in the ICU. The book describes how they navigate through it and find their way, acting as a sensitive witness to the quiet courage and resourcefulness of ordinary people. The book leads the reader into a parallel world: the world of illness. This world, invisible but not hidden, not articulated by but known by the ill, does not readily offer itself to our understanding. In this context, the book reflects on the nature of medicine and nursing, on how doctors and nurses see themselves and how they see each other. Drawing on the words of medical historians, doctor-writers, and nursing scholars, the book examines the relationship of professional and lay observers to the meaning of illness, empathy, caring, and the silence of suffering. In doing so, the book offers up an intimate portrait of the ICU and its inhabitants.
James Kelly
- Published in print:
- 2013
- Published Online:
- August 2016
- ISBN:
- 9780801451683
- eISBN:
- 9780801467653
- Item type:
- chapter
- Publisher:
- Cornell University Press
- DOI:
- 10.7591/cornell/9780801451683.003.0006
- Subject:
- Sociology, Occupations, Professions, and Work
In this chapter, the author talks about what nursing is and what it is not. He begins by citing Florence Nightingale's 1859 book Notes on Nursing, subtitled What It Is and What It Is Not. It was ...
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In this chapter, the author talks about what nursing is and what it is not. He begins by citing Florence Nightingale's 1859 book Notes on Nursing, subtitled What It Is and What It Is Not. It was written for women who had personal charge of the health of others, which would be “almost every woman in England.” He goes on to suggest that nursing was not medicine and that a lot of what was medicine has drifted into nursing, from titrating drugs such as dopamine to interpreting arterial blood gases, deciding what's artifact or arrhythmia, and making decisions all day long—functions that used to be limited to doctors. He also mentions Terry Mizrahi's book Getting Rid of Patients: Contradictions in the Socialization of Physicians, which explores the culture of residents and interns in a southern teaching hospital over several years. The author concludes by reflecting on the relationship between the hospital and poor patients.Less
In this chapter, the author talks about what nursing is and what it is not. He begins by citing Florence Nightingale's 1859 book Notes on Nursing, subtitled What It Is and What It Is Not. It was written for women who had personal charge of the health of others, which would be “almost every woman in England.” He goes on to suggest that nursing was not medicine and that a lot of what was medicine has drifted into nursing, from titrating drugs such as dopamine to interpreting arterial blood gases, deciding what's artifact or arrhythmia, and making decisions all day long—functions that used to be limited to doctors. He also mentions Terry Mizrahi's book Getting Rid of Patients: Contradictions in the Socialization of Physicians, which explores the culture of residents and interns in a southern teaching hospital over several years. The author concludes by reflecting on the relationship between the hospital and poor patients.
Eli Ginzberg
- Published in print:
- 2000
- Published Online:
- October 2013
- ISBN:
- 9780300082326
- eISBN:
- 9780300133011
- Item type:
- chapter
- Publisher:
- Yale University Press
- DOI:
- 10.12987/yale/9780300082326.003.0001
- Subject:
- Sociology, Social Stratification, Inequality, and Mobility
An academic health center (AHC) consists of a medical school and one or more health professional schools. These schools are joined to one or more affiliated teaching hospitals that are under common ...
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An academic health center (AHC) consists of a medical school and one or more health professional schools. These schools are joined to one or more affiliated teaching hospitals that are under common ownership or closely aligned with the medical school. This book focuses on the academic health centers (AHCs) that provide medical care to the urban poor. The urban poor belong to a group of people with income below the federal level of poverty and people who are uninsured. The book centers primarily on the relationship between AHCs and the urban poor subsequent to the passage of Medicare and Medicaid.Less
An academic health center (AHC) consists of a medical school and one or more health professional schools. These schools are joined to one or more affiliated teaching hospitals that are under common ownership or closely aligned with the medical school. This book focuses on the academic health centers (AHCs) that provide medical care to the urban poor. The urban poor belong to a group of people with income below the federal level of poverty and people who are uninsured. The book centers primarily on the relationship between AHCs and the urban poor subsequent to the passage of Medicare and Medicaid.
James Kelly
- Published in print:
- 2013
- Published Online:
- August 2016
- ISBN:
- 9780801451683
- eISBN:
- 9780801467653
- Item type:
- chapter
- Publisher:
- Cornell University Press
- DOI:
- 10.7591/cornell/9780801451683.003.0015
- Subject:
- Sociology, Occupations, Professions, and Work
In this epilogue, the author recalls his conversation with some residents with whom he worked in the intensive care unit (ICU) in the New Mexico teaching hospital and now were leaving because it was ...
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In this epilogue, the author recalls his conversation with some residents with whom he worked in the intensive care unit (ICU) in the New Mexico teaching hospital and now were leaving because it was the end of their rotation. He says he felt a mixture of wonderment, puzzle, pride, and happiness for one resident, who had been so inept and timid the first weeks but now was the resident in charge, supervising the central line. Another intern went the opposite way—she came in with a hard attitude that faded into her real self that wasn't so bad and even a little endearing. A third intern said, “Great working with you guys.” The interns were happy in their way, going on, while the author and others who are staying are also happy in their way.Less
In this epilogue, the author recalls his conversation with some residents with whom he worked in the intensive care unit (ICU) in the New Mexico teaching hospital and now were leaving because it was the end of their rotation. He says he felt a mixture of wonderment, puzzle, pride, and happiness for one resident, who had been so inept and timid the first weeks but now was the resident in charge, supervising the central line. Another intern went the opposite way—she came in with a hard attitude that faded into her real self that wasn't so bad and even a little endearing. A third intern said, “Great working with you guys.” The interns were happy in their way, going on, while the author and others who are staying are also happy in their way.
Eli Ginzberg
- Published in print:
- 2000
- Published Online:
- October 2013
- ISBN:
- 9780300082326
- eISBN:
- 9780300133011
- Item type:
- chapter
- Publisher:
- Yale University Press
- DOI:
- 10.12987/yale/9780300082326.003.0004
- Subject:
- Sociology, Social Stratification, Inequality, and Mobility
This chapter discusses the importance of physician supply issues in the evolution of U.S. health care policy. It first looks at the consequences resulting from the 1963 initiatives to provide ...
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This chapter discusses the importance of physician supply issues in the evolution of U.S. health care policy. It first looks at the consequences resulting from the 1963 initiatives to provide financing of medical and other health professional schools. It then discusses the impact of the Medicare and Medicaid statutes on physician supply in terms of numbers, specialization, practice locations and incomes. Medicare provided multiple sources of graduate medical education (GME) funding to the academic health centers(AHCs) and other teaching hospitals to cover the costs of training and employment of residents. The chapter also discusses the factors involved in the expanding and changing character of the physician supply in the United States since the passage of Medicare.Less
This chapter discusses the importance of physician supply issues in the evolution of U.S. health care policy. It first looks at the consequences resulting from the 1963 initiatives to provide financing of medical and other health professional schools. It then discusses the impact of the Medicare and Medicaid statutes on physician supply in terms of numbers, specialization, practice locations and incomes. Medicare provided multiple sources of graduate medical education (GME) funding to the academic health centers(AHCs) and other teaching hospitals to cover the costs of training and employment of residents. The chapter also discusses the factors involved in the expanding and changing character of the physician supply in the United States since the passage of Medicare.
James Kelly
- Published in print:
- 2013
- Published Online:
- August 2016
- ISBN:
- 9780801451683
- eISBN:
- 9780801467653
- Item type:
- chapter
- Publisher:
- Cornell University Press
- DOI:
- 10.7591/cornell/9780801451683.003.0012
- Subject:
- Sociology, Occupations, Professions, and Work
This chapter considers one question that a family of the patient in the intensive care unit (ICU) wants to ask: whether the doctor can hear. It first discusses Michel de Certeau's claim that people ...
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This chapter considers one question that a family of the patient in the intensive care unit (ICU) wants to ask: whether the doctor can hear. It first discusses Michel de Certeau's claim that people know things, that everyday life is full of know-how, judgments, acquired instincts, competencies, along with the views of Edmund Burke, Luce Giard, and Susan Sontag. In particular, it examines Sontag's contention, articulated in her book Illness as Metaphor, that there was no meaning to be found in illness and that “doctor-writers” are to blame for this myth of illness as “an epic of suffering and the occasion of some kind of self-transcendence.” It also looks at Michel Foucault's discussion of the origin of the teaching hospital, the change in disease theory, and the rise of the medical profession. Finally, it suggests that doctors speak mostly to each other; they don't know what nurses say to the families of the patients and they don't know what families say to nurses.Less
This chapter considers one question that a family of the patient in the intensive care unit (ICU) wants to ask: whether the doctor can hear. It first discusses Michel de Certeau's claim that people know things, that everyday life is full of know-how, judgments, acquired instincts, competencies, along with the views of Edmund Burke, Luce Giard, and Susan Sontag. In particular, it examines Sontag's contention, articulated in her book Illness as Metaphor, that there was no meaning to be found in illness and that “doctor-writers” are to blame for this myth of illness as “an epic of suffering and the occasion of some kind of self-transcendence.” It also looks at Michel Foucault's discussion of the origin of the teaching hospital, the change in disease theory, and the rise of the medical profession. Finally, it suggests that doctors speak mostly to each other; they don't know what nurses say to the families of the patients and they don't know what families say to nurses.
James Kelly
- Published in print:
- 2013
- Published Online:
- August 2016
- ISBN:
- 9780801451683
- eISBN:
- 9780801467653
- Item type:
- chapter
- Publisher:
- Cornell University Press
- DOI:
- 10.7591/cornell/9780801451683.003.0014
- Subject:
- Sociology, Occupations, Professions, and Work
This chapter reflects on the ability of nurses to see the “horizon.” It first considers how James Agee conveys the lives of the tenant farmers by description. Agee experiences beauty, dignity, ...
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This chapter reflects on the ability of nurses to see the “horizon.” It first considers how James Agee conveys the lives of the tenant farmers by description. Agee experiences beauty, dignity, complexity but writes about them as things. In nursing you know only what you've seen, and you know best what you've seen before—this is something medicine knows and teaching hospitals institutionalize. Michel de Certeau believes that everyday life could not be represented; there could be no theory of it; it could not be known. This chapter suggests that a border separates nurses from patients and their families, and between medicine and nursing and the ill. It also considers the idea that the horizon “seems to be created by everything there is without being any of them”.Less
This chapter reflects on the ability of nurses to see the “horizon.” It first considers how James Agee conveys the lives of the tenant farmers by description. Agee experiences beauty, dignity, complexity but writes about them as things. In nursing you know only what you've seen, and you know best what you've seen before—this is something medicine knows and teaching hospitals institutionalize. Michel de Certeau believes that everyday life could not be represented; there could be no theory of it; it could not be known. This chapter suggests that a border separates nurses from patients and their families, and between medicine and nursing and the ill. It also considers the idea that the horizon “seems to be created by everything there is without being any of them”.
Melvyn C. Usselman
- Published in print:
- 2015
- Published Online:
- January 2016
- ISBN:
- 9780226245737
- eISBN:
- 9780226245874
- Item type:
- chapter
- Publisher:
- University of Chicago Press
- DOI:
- 10.7208/chicago/9780226245874.003.0001
- Subject:
- History, History of Science, Technology, and Medicine
This chapter describes the life and education of W. H. Wollaston from his birth in 1766 to his years as a country physician the 1790s. Growing up in a large family steeped in religion and natural ...
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This chapter describes the life and education of W. H. Wollaston from his birth in 1766 to his years as a country physician the 1790s. Growing up in a large family steeped in religion and natural philosophy, Wollaston was guided by his father Francis through preliminary schooling at Charterhouse to medical studies and a fellowship at Caius College, Cambridge. Following a program of studies recommended by his uncle William Heberden, Wollaston obtained his Bachelor of Medicine degree in 1788, and spent the next five years acquiring valuable medical skills at the teaching hospitals of London. Details are given of his MD degree of 1793 and four years of doctoring in Bury St. Edmunds, together with accounts of his election to the Royal Society in 1793 and the Royal College of Physicians in 1794. Wollaston’s exposure to chemistry and the chemist Smithson Tennant at Cambridge is also described.Less
This chapter describes the life and education of W. H. Wollaston from his birth in 1766 to his years as a country physician the 1790s. Growing up in a large family steeped in religion and natural philosophy, Wollaston was guided by his father Francis through preliminary schooling at Charterhouse to medical studies and a fellowship at Caius College, Cambridge. Following a program of studies recommended by his uncle William Heberden, Wollaston obtained his Bachelor of Medicine degree in 1788, and spent the next five years acquiring valuable medical skills at the teaching hospitals of London. Details are given of his MD degree of 1793 and four years of doctoring in Bury St. Edmunds, together with accounts of his election to the Royal Society in 1793 and the Royal College of Physicians in 1794. Wollaston’s exposure to chemistry and the chemist Smithson Tennant at Cambridge is also described.
